Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
As a Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of health services.
Responsibilities
- Responsible for initial review and triage of Care Teams 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.
- Utilizes Med Compass and 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 nurse or medical direction in the appropriate setting at the most appropriate expense.
- Promotes communication, both internally and externally to enhance effectiveness of medical management services.
- Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
- Provides support services to team member.
Requirements
- 2-4 years of experience within the healthcare field, medical/health setting, medical billing, and coding.
- Experience in call center or customer service environment.
- Ability to work independently, meeting deliverables and deadlines with demonstrating and outgoing, enthusiastic and caring presence telephonically.
- Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude and strong written and oral communication skills.
- This role requires the ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems.
- Technically proficient, with the ability to navigate computer systems, and digital tools efficiently.
- Ability to work independently while collaborating effectively with clinical teams.
- Excellent communication skills for interacting with providers and internal stakeholders.
Work Schedule
- Training and Work schedule will be between the hours of 8:00 AM-8:00 PM ET.
- Training will be for approximately 4 to 8 weeks 8-hour training shift between this timeframe within your designated time zone.
- Position is for a Weekend Care Management Associate position 10 hour days (4 days per week) with schedule of 7am to 5:30pm in your respective time zone, Saturday - Tuesday.
- Weekend and Holiday hours will be required.
Benefits
- Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
- Medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.