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Service Coordinator 3-Case Management Associate

Primary Location: San Antonio, TX
Additional Locations: TX-Hondo, TX-Kerrville, TX-New Braunfels, TX-San Antonio, TX-Schertz, TX-Seguin
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.


The Service Coordinator 3, (Case Management Associate) supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Additional duties may include, outreach to members that have been difficult to locate. This position is office based. Some travel to member locations may be required. Travel will be less than 10% of the time, with personal vehicle. Must have active and valid TX driver's license, reliable transportation and vehicle insurance.


Fundamental Components:
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. Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan. Schedules members for in home assessments conducted by other members of the team. Monitors non-targeted cases for entry of appropriate discharge date and disposition. Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff. Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs. Utilizes Aetna systems to build, research and enter member information, as needed. Support the Development and Implementation of Care Plans. May assist with obtaining signatures on Care Plans. Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services 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. Assists with completion of authorizations fore services including entering information into authorization systems and ensuring accurate generation and mailing of letters. Utilizes claims, pharmacy and other data sources to connect with members that have been difficult to reach. 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. May assist in the research and resolution of claims payment issues. Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.



Background Experience:
  • 2-4 years experience as a medical assistant, office assistant
  • Direct experience with the ABD/SSI population in three of the last five years
  • High School Diploma or G.E.D.
  • Bilingual skills preferred (Spanish)
  • Effective communication skills, verbal and written
  • Effective organization skills
  • Familiarity with basic medical terminology and concepts used in care management
  • Strong customer service background and skills to coordinate service delivery including attention to members, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants


Additional Job Information:
  • BEXAR SERVICE AREA: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, and Wilson counties
  • Working environment with productivity and quality expectations
  • Ability to multitask, prioritize, and effectively adapt to a fast changing environment


Required Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Service - Demonstrating Service Discipline

Desired Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Leadership - Collaborating for Results

Functional Skills:
Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - FE Clinical coverage & policies, Communication - Member communications, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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.

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