Job Overview

Care Management Associate – Aetna – Salary: $20‑30/hour – Location: Boise, USA – Educational Requirements: Bachelor's Degree.

Enterprise evaluation: The Aetna higher health of West Virginia plan has a 26+ yr history of partnering with the nation to provide West Virginia’s Medicaid populace with remarkable health care coordination and carrier. The plan also has been chosen to provide care coordination to complex foster care youngsters of the nation. Via a sturdy, localized group, an progressive care control version, and innovative provider and network advocacy partnerships, Aetna's better health of West Virginia has efficiently assisted the country in achieving high fine standards and results for the Medicaid population throughout the country. The fitness plan truly embodies the commitment of West Virginian’s help West Boise. At Aetna higher fitness of West Virginia, you could be very fine you could be working with robust teams devoted to helping our members and with opportunities for career growth. We can aid you all the manner!

Responsibilities

• Liable for initial assessment and triage of participants.
• Manages populace fitness member enrollment for toddler and own family welfare.
• Manages a low-tier member caseload.
• Developing wellness plans, imparting network assets, reviewing gaps in care, administering health questionnaires, and different centered baby welfare dreams applicable to population health.
• Completes outbound calls to become aware of and interact with suitable network resources.
• Displays participants the use of focused intervention business guidelines and methods to become aware of wished medical offerings, make suitable referrals to clinical offerings personnel, and coordinate the desired offerings in accordance with the advantage plan.
• Identifies triggers for referral into Aetna’s case management, sickness management, mixed services, and another area of expertise packages.
• Uses Aetna systems to construct, research, and enter member facts, as needed.
• Supports the improvement and implementation of care plans.
• Coordinates and arranges for health care service transport beneath the route of nurse or clinical director inside the most suitable setting at the maximum suitable rate by way of identifying opportunities for the patient to utilize participating providers and services.
• Promotes communication, each internally and externally to enhance the effectiveness of scientific control offerings (e.g., fitness care companies, and fitness care crew members respectively).
• Performs non‑clinical research pertinent to the status quo, maintenance, and closure of open cases.
• Provides assistance offerings to team members by way of answering telephone calls, studying data, and assisting in fixing issues.
• Adheres to compliance with guidelines and regulatory standards.
• Keeps accurate and complete documentation of required statistics that meets danger control, regulatory, and accreditation necessities.
• Protects the confidentiality of member records and adheres to organization guidelines regarding confidentiality.
• May additionally assist within the studies and resolution of claims fee issues.
• Helps the administration of the medical institution care, case‑control and high‑quality control techniques in compliance with various legal guidelines and policies, Iraq and/or ncqa standards, case‑control society of the USA (CMSA) standards wherein relevant, at the same time as adhering to employer coverage and tactics.
• Effective communique, telephonic and enterprise abilities with the capability to be agile, dealing with a couple of priorities at one time, and adapting to trade with enthusiasm.
• Demonstrates potential to satisfy daily metrics with pace, accuracy, and a fine mindset.
• Sturdy customer support abilities to coordinate carrier transport along with attention to clients, sensitivity to problems, proactive identity and determination of problems to promote high‑quality outcomes for participants, adhering to care control strategies (to encompass, but no longer restrained to, privacy and confidentiality, satisfactory management strategies in compliance with regulatory, accreditation tips, company policies, and approaches).
• Completes documentation of each member's name within the electronic report, thoroughly finishing required actions with a high degree of element to make certain compliance requirements are met with performance.
• Works independently and accurately, meeting deliverables and deadlines even as demonstrating an outgoing, enthusiastic, and caring presence telephonically.
• Capacity to correctly participate in a multi‑disciplinary group such as internal and outside members.

Required Qualifications

• Need to live in West Virginia; any region.
• 2‑4 years revel in the healthcare field or running with foster, baby, and circle of relatives welfare populations (e.g., experience in a clinical office, sanatorium setting, case employee in‑network fitness setting).
• 2+ years experience with private computer systems, keyboard, and multi‑machine navigation, and MS Workplace Suite packages (Outlook, phrase, Excel, teams, sharepoint, and many others.)

Preferred Qualifications

• Facts access and documentation within member data is favored.
• Familiarity with basic medical terminology and ideas utilized in care control is favored.
• Robust organizational abilties, such as effective verbal and written verbal exchange capabilities is favored.
• A pals diploma is preferred.

Education

High school degree or G.E.D.

EEO Statement

We are an affirmative action employer and a same‑possibility business; we do not discriminate in recruiting, hiring, promotion, or any other employee movement based purely on race, ethnicity, color, national origin, gender, sexual orientation, gender identification or expression, religion, age, capability, included veteran reputation, or any other factor covered by applicable federal, state, or local law. We proudly aid and inspire humans with navy revel in (energetic, veterans, reservists, and countrywide defend) in addition to army spouses to apply for Aetna health job possibilities.