Req ID: 21096BR
This is an office based position with potential to work from home based on performance.POSITION SUMMARY
Support coordination of medical services with data entry and transfer. Including case management screening, support and implementation of care plans to promote effective utilization of health care services
Fundamental Components
Supports the Development and Implementation of case management 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
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
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
BACKGROUND/EXPERIENCE d
Strong customer service skills
Effective communication, telephonic and organization skills
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.
Familiarity with basic medical terminology and concepts used in care management.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Customer Service/Customer service - production environment/1-3 Years
Functional - Medical Management/Medical Management - Coding/1-3 Years
Functional - Customer Service/Customer Service - Member Services - HMO products/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1-3 Years/End User
REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals/FOUNDATION
General Business/Communicating for Impact/ADVANCED
Service/Working Across Boundaries/FOUNDATION
DESIRED SKILLS
Benefits Management/Understanding Clinical Impacts/ADVANCED
Technology/Leveraging Technology/FOUNDATION
Telework Specifications
Option for telework will be evaluated after a certain period of employment
ADDITIONAL JOB INFORMATION
Fast pace environment engaging seniors to help to promote optimum health
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health Care