03 Feb
TX STAR+PLUS Care Management Associate
Texas, Hondo 00000 Hondo USA

Vacancy expired!

Req ID: 68155BRJob DescriptionAt Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.The Care Management Associate, Service Coordinator 3, supports 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. Additional duties may include, outreach to members that have been difficult to locate. This position is office based. Some travel to member locations may be required. Travel will be less than 10% of the time, with personal vehicle. Must have active and valid TX driver's license, reliable transportation and vehicle insurance.Fundamental Components included but are not limited to: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. Schedules members for in home assessments conducted by other members of the team. 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. May assist with obtaining signatures on 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. Assists with completion of authorizations fore services including entering information into authorization systems and ensuring accurate generation and mailing of letters. Utilizes claims, pharmacy and other data sources to connect with members that have been difficult to reach. 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. 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. Qualifications Requirements and Preferences:

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

Direct experience with the ABD/SSI population in three of the last five years

High School Diploma or G.E.D.

Bilingual skills preferred (Spanish)

Effective communication skills, verbal and written

Effective organization skills

Familiarity with basic medical terminology and concepts used in care management

Strong customer service background and skills to coordinate service delivery including attention to members, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.

Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.

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

Functional Skills:Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - FE Clinical coverage & policies, Communication - Member communications, Medical Management - Medical Management - Managed Care/Insurance Clinical StaffTechnology Experience:Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft ExcelRequired Skills:Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Service - Demonstrating Service DisciplineDesired Skills:Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Leadership - Collaborating for ResultsAdditional Job Information:

BEXAR SERVICE AREA: Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina, and Wilson counties

Working environment with productivity and quality expectations

Ability to multitask, prioritize, and effectively adapt to a fast changing environment

Benefit EligibilityBenefit eligibility may vary by position.Job Function: HealthcareAetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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