Job Abstract

Position Summary

Business Hours 8:00 AM to 5:00 PM Eastern Standard Time (EST).

The Care Management Associate supports comprehensive coordination of medical services including completing member outreaches, assisting with service authorizations, and member mailings.

Help us elevate our patient care to a whole new level! Join our Aetna FIDE team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in markets across the country.

Additional responsibilities include but not limited to the following:

- Initial outreach and scheduling of assessments

- Utilizes Dynamo, QNXT, state agency systems and other Aetna systems to build, research, and enter member information as needed.

- Support the development and implementation of care plans.

- Coordinates and arranges for health care service delivery under the direction of the nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the member 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.)

- 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.

- Adheres to compliance with 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.

Required Qualifications

?

- 2 years of experience preferably in customer service, telemarketing and/or sales

- Demonstrated knowledge and use of Microsoft Office Suite including Outlook, Word, Excel, Teams, Etc.

Preferred Qualifications

- Previous MCO experience

Education

High School diploma or equivalent GED