Care Management Associate (CMA)

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The Care Management Associate (CMA) role is a full-time remote telework position. Qualified candidates must reside in Ohio, West Virginia, Kentucky, or Louisiana. This position manages enrollment for Children’s Specialty (CS) program including foster, child and family welfare population health members and other programs serving children with special healthcare needs and carries a caseload.

The Care Management Associate supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of Wellness Plans to promote effective utilization of healthcare services.

This position promotes/supports quality effectiveness of healthcare services. This is a telework position and qualified candidates must reside in Ohio, West Virginia, Kentucky, or Louisiana. Schedule is M-F 8-5 EST, standard business hours; however must be able to work two evenings per week to 7pm EST with an adjusted start time. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance to accommodate business needs.

Position Responsibilities:

• Responsible for initial review and triage of members.
• Manages population health member enrollment for child and family welfare.
• Manages a low-tier member caseload.
• Develops wellness plans, provides community resources, reviews gaps in care, administers health questionnaires, and targets other child welfare goals applicable to population health.
• Completes outbound calls to identify and engage appropriate community resources.
• Screens members using targeted intervention business rules and processes to identify needed medical services, makes appropriate referrals to medical services staff and coordinates the required services in accordance with the benefit plan.
• Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Supports the development and implementation of wellness plans.
• Coordinates and arranges for health care service delivery under the direction of a nurse or medical director in the most appropriate setting at the most appropriate expense.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services.
• Performs non-medical research pertinent to the establishment, maintenance and closure of open cases.
• Provides support services to team members by answering telephone calls, 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.

Required Qualifications:

• Must reside in Ohio, West Virginia, Kentucky, or Louisiana.
• 2-4 years’ experience in the healthcare field or working with foster, child and family welfare populations.
• Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
• 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.
• 2+ years’ demonstrated proficiency with personal computers, keyboard and multi-system navigation, and MS Office Suite application.
• Some in-state travel (5-10%) may be required for meetings, community engagement and training.
• Must pass CANS certification exam within the first 3 months of employment.

Preferred Qualifications:

• Motivational interviewing skills
• Call Center experience
• Managed Care experience

Education:

• High school diploma or G.E.D.

Anticipated Weekly Hours:

• 40

Time Type:

• Full-time

Pay Range:

• $18.50 - $35.29

Benefits:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs