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Aetna is now a CVS Health Company

Care Management Associate Lead

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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Description:
Assist the supervisor in leading the team in monitoring timeframes, completing regulator reports in an efficient and accurate manner, and writing notice of action letters for both Medicare and Medicaid markets. In addition, there is a possibility of helping the prior authorization intake team with calls and data entry.

Fundamental Components:
The main function of this role will be to complete reports that are turned into our regulators at Medicare and Medicaid. The reports need to be done accurately, with a major focus on detail, and finding mistakes before submission. This role will also be to help the team write or audit notice of action letters. These letters creatively translate physical health, behavioral health, and medication information into member readable language using business knowledge and available resource tools. The letters must translate complicated and technical medical terminology into clear, concise communication for various target audiences. The letters follow Medicare and Medicaid guidance around language and templates.
In addition to reports and notice of action letters, you may have to take phone calls and faxes from providers (clinics, hospitals, doctors) requesting prior authorization approval, make calls to providers or members, data entry any faxes that are received from providers, and complete special projects in accordance to business needs (i.e. return mail, member surveys, sorting).
The above job duties require timely submissions and meeting time frames according to the Medicare and Medicaid market. The team lead must be able to access documentation libraries to ensure communication is consistent, communicate any errors and potential problems with leadership, and assign authorizations as needed to help facilitate timeliness. Our focus is on compliance and doing the right things for the right reasons. This is a high production team, so you will need to be efficient, productive and thorough in all work that is done. You will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our providers and our members. This is a great opportunity to bring your skills and talents to a role where you’ll have a chance to make an impact.

Background Experience:
  • Computer literacy in order to navigate through internal/external computer systems, including Windows 10, Outlook, Excel and Word.
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants.
  • Familiarity with basic medical terminology and concepts used in care management.
  • Effective written and spoken communication, telephonic and organization skills.
  • Understanding of health care business, and business or technical writing preferred.
  • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to health issues, proactive identification and resolution of issues to promote positive outcomes for members.


Additional Job Information:
This position teaches a candidate how to effectively participate in a multi-disciplinary team. There is opportunity to learn medical terminology and concepts used in care management. Opportunity to develop strong customer service skills, effective communication, telephonic and organizational skills. This position would also provide an opportunity to create regulatory correspondence that is member/provider focused. This position has great growth potential within this company.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Ensuring Project Discipline, General Business - Maximizing Work Practices, Technology - Leveraging Technology

Desired Skills:
General Business - Turning Data into Information, Leadership - Collaborating for Results, Service - Demonstrating Service Discipline, Service - Handling Service Challenges, Service - Working Across Boundaries

Functional Skills:
Administration / Operation - Data Entry, Customer Service - Customer service - Medical Transcription, Customer Service - Customer service - production environment

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel, Operating System - Windows

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)

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