Job Description
The ideal candidate must live in the West Virginia State.
- Job responsibilities include but not limited to:
- Supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
- Promoting/supporting quality effectiveness of Healthcare Services.
- 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.
- 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 eTUMS and other Aetna systems to build, research and enter member information, as needed.
- Support the Development and Implementation of Care Plans.
The Care Management Associate must have 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; and the ability to effectively participate in a multi-disciplinary team including internal and external participants.
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