Aetna Inc. Topeka , KS 66604
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.
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.
2-4 years experience as a medical assistant, office assistant.
Familiarity with medical terminology.Managed care experience is preferred.
Familiarity with Medicaid is desired.
Medical Management/Medical Management
Direct patient care/1-3 Years
General Business/Maximizing Work Practices/ADVANCED
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.
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