Description:
Supports comprehensive coordination of medical services including Assessments, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.

Fundamental Components:

• Make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
• 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.
• Supports the administration of the 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, in a MCO or clerical/assistant position.
• High School Diploma or G.E.D.

Additional Job Information:

• 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.

Required Skills:
General Business - Communicating for Impact, Service - Handling Service Challenges, Service - Improving Constituent-Focused Processes

Desired Skills:
Service - Demonstrating Service Discipline, Service - Managing Organizational Dynamics, Service - Providing Solutions to Constituent Needs

Functional Skills:
Communication - Employee communications, Customer Service - Customer Service - Long Term Care

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

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. 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)