Care Management Associate
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About The Position
Support comprehensive coordination of medical services including Care Team intake and outreach, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of health care services. Responsible for initial review and outreach tasks. Tracks Medicaid redetermination and researches eligibility issues. Tracks and ensures Level of Care compliance standards set by the State. Utilizes Dynamo, QNXT and other Aetna systems to build, research and enter member information, as needed. Assists Case Managers with coordination of benefits 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 Policies and Regulatory Standards. Maintains accurate and complete documentation of required information that meets contract requirements. Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Create authorizations, outreach providers, bridge service gaps, assist with claims resolution and monitor authorization & claims reports.
