Req ID: 17687BR
In order to be considered for this exciting telework/work-at-home opportunity with Aetna, you must be comfortable collaborating with remote trainers, management, and teammates. You must also be located within a reasonable distance to either Aetna''s Blue Bell, PA or Hartford, CT office and be comfortable participating in a rotating evening shift until 9:00pm.POSITION SUMMARY
As a Remote Care Management Associate, you will be a part of the Aetna Custom Care Management Unit, which is a holistic program derived from our current Case Management and Disease Management Programs, blending the core components of each to deliver a seamless program of education and guidance for our members along with their family. In this role, you will work closely with the nurses to manage intake and screening, researching and collecting information, determining member coverage, managing flow control, triaging HICO and Pulse cases, managing the assignment and distribution of cases to nurses daily, assist with screening of AOS opportunites, and work as part of a rotating coverage to manage the CCMU queue in operation from 11:00am-9:00pm ET.Fundamental Components of the Care Management Associate role include, but are not limited to:- Initial review and triage of Care Team tasks (*)
- Identifying principle reason for admission, facility, and member product to correctly apply intervention assessment tools (*)
- Screening patients using targeted intervention business rules and processes to identify needed medical services, and making appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan (*)
- Monitoring non-targeted cases for entry of appropriate discharge date and disposition (*)
- Identifying and refering outlier cases (e.g., Length of Stay) to clinical staff (*)
- Identifying triggers for referral into Aetna''s Case Management, Disease Management, Mixed Services, and other Specialty Programs (*)
- Utilizing eTUMS and other Aetna systems to build, research and enter member information, as needed (*)
Support the Development and Implementation of Care Plans
- Coordinating and arranging 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
- Promoting communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively) (*)
- Performing non-medical research pertinent to the establishment, maintenance and closure of open cases (*)
- Providing support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems (*)
- Adhering to Compliance with PM Policies and Regulatory Standards
- Maintaining accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements (*)
- Protecting the confidentiality of member information and adheres to company policies regarding confidentiality (*)
- Assisting in the research and resolution of claims payment issues
- Supporting 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 (*)
DESIRED BACKGROUND/EXPERIENCE
Medical/Medical Assistant or Medical Office Personnel Experience/2-4 Years
Professional/Call Center or Inbound Queue Experience/1-3 years
Medical/Medical Terminology/1-3 Years
EDUCATION
The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional_Experience/Functional_Focus/1-3 Years
TECHNOLOGY EXPERIENCES
Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User
REQUIRED SKILLS
Technology/Leveraging Technology/FOUNDATION
Service/Handling Service Challenges/FOUNDATION
ADDITIONAL COMPANY INFORMATION
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