Care Management AssociatePrimary Location: Louisville, KY
Additional Locations: KY-Louisville Apply
- Responsible for initial review and triage of Care Team tasks.
- Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
- Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
- Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
- Performs non-medical research pertinent to the establishment, maintenance and closure of open cases
- Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
- Adheres to Compliance with PM Policies and Regulatory Standards.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Member outreach to complete Health Risk Assessment
- Assists members who call into the phone queue
- Completes mailings/materials requests
- 2-4 years experience as a medical assistant, office assistant.
- High School Diploma or G.E.D.
- Effective communication, telephonic and organization skills.
- Familiarity with basic medical terminology and concepts used in care management.
- Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
- Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Promotes/Supports quality effectiveness of Healthcare Services
- Assignment of Lock-In providers; Enrolling Lock-in members
- Reviewing and updating request for Lock-in provider and pharmacy changes
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