Introduction to Aetna and the Role
Aetna, a leading healthcare organization, is seeking a highly motivated and results-driven individual to join their team as a Care Management Associate. This entry-level position offers a unique opportunity for professional growth and development in the healthcare industry. As a Care Management Associate, you will play a vital role in coordinating healthcare services, enrolling individuals into care management programs, and promoting effective utilization of healthcare benefits. If you are passionate about delivering exceptional customer service and making a positive impact on people's lives, we encourage you to apply for this exciting opportunity.
Job Summary
The Care Management Associate will be responsible for comprehensive coordination of healthcare services through telephonic outreach to enrolled individuals. This role requires a highly energetic and dynamic blend of sales, healthcare guidance, and customer service skills. The successful candidate will be accountable for direct member engagement and enrollment, working with case assignment, and connecting identified individuals to care managers. By effectively enrolling individuals into care management, you will support the implementation of care plans to promote effective utilization of healthcare benefits, enhancing quality outcomes.
Key Responsibilities
- Takes the lead in member outreach to assess individuals for risk definition and ensure compliance with outreach and contact requirements.
- Identifies triggers for referral into Aetna's care management, chronic condition disease management, blended services, and other care management and/or specialty programs.
- Monitors individuals using designated intervention business rules and processes to identify required clinical benefits, make appropriate referrals to clinical services staff, and guide the expected services according to the benefit plan.
- Receives warm transfers from IVR outreach, member benefits, social impact team, and monitors individuals using designated intervention rules and processes to identify required services and make appropriate referrals to clinical services staff.
- Enhances communication, both internally and externally, to improve the effectiveness of care management services (e.g., providers, and healthcare colleagues respectively).
- Coordinates and organizes for healthcare service delivery under the direction of the care manager or clinical director in the most suitable setting at the most appropriate cost by identifying opportunities for the member to utilize participating providers and services.
- Provides support services to care coordination colleagues by answering calls, taking messages, researching information, and assisting in problem-solving.
- Performs non-clinical research relevant to the establishment, maintenance, and conclusion of open cases.
- Ability to effectively participate in a multi-disciplinary team, including internal and external stakeholders.
- Performs non-clinical research relevant to the establishment, maintenance, and conclusion of open cases.
- Offers administrative support to additional care coordination resources (value adds) program to include confirming member eligibility and processing requests.
- Adheres to compliance with policies and procedure/administrative rules.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Safeguards the confidentiality of member data and adheres to company policies regarding confidentiality.
- Completes documentation of each member call in the electronic record, fully completing expected actions with a high degree of detail to ensure compliance requirements are met with efficiency.
Essential Qualifications
To be successful in this role, you will need:
- A Bachelor's degree in a relevant field.
- 3 years of experience in the healthcare field (e.g., clinical office, hospital setting, or clinical billing/coding).
- 3+ years of experience using a computer, keyboard navigation, navigating various systems and applications, and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).
- Solid transportation and willingness to travel to the Oklahoma City office as needed, rare. Mileage is reimbursed per our company expense reimbursement policy.
- Strong client service skills to facilitate service delivery, including attention to customers, prevention of issues, proactive identification, and resolution of issues with positive outcomes for members, adhering to care management processes (to include, but not limited to, confidentiality and privacy, quality management processes in compliance with regulatory, accreditation rules, company policies, and procedures).
- Ability to meet daily metrics with speed, accuracy, and a positive attitude.
- Works independently and skillfully, meeting expectations and time constraints while demonstrating an active, energetic, and caring presence.
- Strong organizational skills, including effective verbal and written communication skills.
Preferred Qualifications
While not essential, the following qualifications are desirable:
- Data entry and documentation within member records.
- Experience with basic medical terminology and concepts used in care management.
Career Growth Opportunities and Learning Benefits
Aetna is committed to the growth and development of its employees. As a Care Management Associate, you will have access to a range of training and development opportunities, including:
- Comprehensive onboarding program to ensure a smooth transition into the role.
- Ongoing training and development opportunities to enhance your skills and knowledge in care management.
- Opportunities for career advancement within the company.
- Access to a range of employee benefits, including health insurance, retirement savings, and paid time off.
Work Environment and Company Culture
Aetna is a dynamic and supportive work environment that values diversity, equity, and inclusion. As a Care Management Associate, you will be part of a team that is passionate about delivering exceptional customer service and making a positive impact on people's lives. Our company culture is built on a foundation of:
- Respect and empathy for our members and colleagues.
- A commitment to excellence in everything we do.
- A focus on innovation and continuous improvement.
- A supportive and inclusive work environment that values diversity and promotes employee well-being.
Compensation, Perks, and Benefits
Aetna offers a competitive salary package, commensurate with experience, as well as a range of benefits, including:
- Health insurance.
- Retirement savings plan.
- Paid time off.
- Opportunities for career advancement and professional growth.
- Access to a range of employee discounts and perks.
Conclusion
If you are a motivated and results-driven individual who is passionate about delivering exceptional customer service and making a positive impact on people's lives, we encourage you to apply for this exciting opportunity. As a Care Management Associate, you will be part of a dynamic and supportive team that values diversity, equity, and inclusion. Don't miss out on this opportunity to join Aetna and build a rewarding and challenging career in the healthcare industry. Apply today and let's build the future together!
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