Care Management Associate
Posted on: 15 Jan 2021
Sugar Land, TX
Job Description
Job Description
Responsible for initial review and triage of Care Team tasks. 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. (*)Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively) (*) 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 PM 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
The ideal candidate should have strong customer service skills -Effective communication, telephonic and organizational skills -Candidates will need effective time management, ability to manage multiple priorities -Strong teamwork skills -Must possess strong computer and keyboarding skills
Preferred Qualifications
Knowledge of managed care, preferred -2-4 years experience in telephonic customer service preferred ADDITIONAL JOB INFORMATION: Willingness to work flexible hours desired. Work hours 8:00- 8:00 ET 3 day shifts, 2 evening shifts 11:30-8:00 ET.
Education
High School diploma, G.E.D. or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Aetna
Hartford, CT
Aetna Inc. operates as a health care benefits company in the United States. It operates through three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment offers medical, pharmacy benefit management service, dental, behavioral health, and vision plans on an insured and employer-funded basis. It also provides point-of-service, preferred provider organization, health maintenance organization, and indemnity benefit plans, as well as health savings accounts and consumer-directed health plans.
In addition, this segment offers Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers’ compensation administrative services, and products that provide access to its provider networks in select geographies. The Group Insurance segment offers life insurance products, including group term life insurance, voluntary spouse and dependent term life insurance, group universal life insurance, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which provide the benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities.
The Large Case Pensions segment manages various retirement products comprising pension and annuity products primarily for tax-qualified pension plans. The company provides its products and services to employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is based in Hartford, Connecticut. As of November 28, 2018, Aetna Inc. operates as a subsidiary of CVS Pharmacy, Inc.
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IndustryInsurance
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No. of Employees47,950
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Website
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Jobs Posted12677
