Care Management Associate

Aetna Inc. Topeka , KS 66604

Posted 2 months ago

Job Description:

POSITION SUMMARY

Provide comprehensive healthcare management to facilitate delivery of appropriate quality healthcare, promote cost effective outcomes and improve program/operational efficiency involving clinical issues.Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Supports a telephone queue for member welcome calls, as assigned.

Fundamental Components:

Responsible for initial review and triage of Care Team 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. 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. Support the Development and Implementation of Care Plans.Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient 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 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. May assist in the research and resolution of claims payment issues.May perform community health worker tasks, as assigned.Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures. Supports a telephone queue for member welcome calls, as assigned.

BACKGROUND/EXPERIENCE:

  • 2-4 years experience as a medical assistant, office assistant.

  • Familiarity with medical terminology.Managed care experience is preferred.

  • Familiarity with Medicaid is desired.

EDUCATION

  • The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

  • Functional
  • Medical Management/Medical Management

  • Direct patient care/1-3 Years

  • Functional
  • Administration / Operations/Document production & distribution/1-3 Years
  • Functional
  • Administration / Operations/File Maintenance/1-3 Years
  • Functional
  • Administration / Operations/Data Entry/1-3 Years
  • Functional
  • Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

TECHNOLOGY EXPERIENCES

  • Technical
  • Desktop Tools/Microsoft Word/1-3 Years/End User
  • Technical
  • Desktop Tools/TE Microsoft Excel/1-3 Years/End User
  • Technical
  • Desktop Tools/Microsoft Outlook/1-3 Years/End User
  • Technical
  • Desktop Tools/Microsoft SharePoint/1-3 Years/End User

REQUIRED SKILLS

  • Benefits Management/Interacting with Medical Professionals/FOUNDATION
  • Benefits Management/Promoting Health Information Technology/ADVANCED
  • General Business/Communicating for Impact/ADVANCED

DESIRED SKILLS

General Business/Maximizing Work Practices/ADVANCED

Technology/Leveraging Technology/FOUNDATION

Service/Creating a Differentiated Service Experience/ADVANCED

ADDITIONAL JOB INFORMATION

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.

Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Familiarity with basic medical terminology and concepts used in care management.

Effective communication, telephonic and organization skills.

Travel may be required to member locations; use of personal vehicle with valid KS drivers license, proof of vehicle insurance and reliable transportation.

Areyou ready to join a company that is changing the face of health care across thenation? Aetna Better Health of Kansas is looking for people like you who valueexcellence, integrity, caring and innovation. As an employee, you'll join ateam dedicated to improving the lives of KanCare members. Our vision incorporatescommunity-based health care that works. We value diversity. Align your careergoals with Aetna Better Health of Kansas, and we will support you all the way.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Retail Management Topeka KS And Surrounding Area

Gamestop Corp.

Posted 3 days ago

VIEW JOBS 11/13/2018 12:00:00 AM 2019-02-11T00:00 Job Snapshot * Location: 1725 Southwest Wanamaker Road Topeka, KS * Job Type: GameStop Retail Management * Experience: Not Specified * Date Posted: 10/24/2018 Job Description PLEASE NOTE: Your application for this position includes all locations within the district. District Manager – role is similar to an innovative business entrepreneur and owner, with special emphases on comp sales, used sales, talent retention, trades, guest experience, and loss prevention. Within GameStop's broadly defined parameters, District Leaders have the autonomy, authority, and responsibility to inspire outstanding business results through others as the leaders of their district's performance development strategy. Store Manager – directly influences the performance of everyone who interacts with guests and supports a solution selling environment. The Store Leader is responsible for fostering a selling culture that creates unique, complete solutions that exceed guest's expectations. The Store Leader ensures best-in-class guest service for every GameStop guest by using elements of GameStop's buy, sell, trade, and reservation business model, the Circle of Life. The Store Leader makes discretionary decisions involving all sales initiatives, operational effectiveness, marketing, scheduling, employment, and all other aspects of the day-to-day business processes of a GameStop store, which will demonstrate the commitment to a unique solutions selling experience for all guests. Job Requirements Qualified District Manager candidates will possess the following: * 3 years of successful, related experience as a multi-unit leader required * Bachelor of Arts or Bachelor of Science from a regionally accredited college or university in a related field of study, such as business administration, is required, although equivalent experience may be accepted as a substitute * Proven ability to work productively with others, welcome and adapt well to change, communicate thoughts and feelings effectively, and receive and respond to feedback from others maturely Travel Requirements: 60 to 70% with occasional overnight stays. Qualified Store Manager candidates will possess the following: * Must be at least 18 years of age and present state-required proof of age documents * Must be able to provide genuine and friendly assistance to every guest during every visit * High school diploma or GED required; An Associate's or accredited Bachelor's degree with an emphasis in business, marketing, merchandising, or related field preferred * Three or more years of retail sales, guest service, and/or management/leadership experience required; at least 1 year of retail management experience preferred * Must be able to work alone and move throughout the store unassisted, for extended periods (up to 12 hours per day) * Must be able to lift and/or move objects and displays (up to 30 lbs.), bend, stoop, reach with arms and hands, and climb on ladders * Must be able to occasionally travel unassisted via car and/or plane to offsite conferences and meetings (less than 10%) * Must be able to work a minimum of 44 hours per week Gamestop Corp. Topeka KS

Care Management Associate

Aetna Inc.