Care Management Associate
Core
Evaluates patients using intervention rules to identify needed medical services, makes referrals, and coordinates care delivery under the direction of nurses or medical directors.
Role type
Care Management Associate (Medical Case Management)
Builds
Coordinated care plans and service delivery for health plan members
Domain
Health Insurance / Medical Case Management
Required skills
Patient triage, referral coordination, non-medical research, documentation, telephonic communication, data entry, Microsoft Office proficiency
Preferred skills
Medical terminology, call center experience, medical office experience, problem-solving
Technologies
Aetna systems, Microsoft Word, Outlook, Excel
Responsibilities
Evaluate patients using targeted intervention business rules to identify needed medical services; Make appropriate referrals to medical services staff and coordinate required services; Perform non-medical research for case establishment, maintenance, and closure; Answer telephone calls from providers and members; Maintain accurate documentation meeting regulatory requirements; Assist in obtaining discharge dates and follow-up referrals.
Seniority
Mid-level, hands-on IC