Job Description
Job Description
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs - and for Aetna to keep its competitive edge.
The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members. Our Engagement Care Management Associates demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative. The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer. By successfully enrolling members into care management, further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness.
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 procedure/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.
Required Qualifications
* Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
* Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude.
* 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
* Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
* Works independently and competently, meting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically.
* Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Preferred Qualifications
* 2 - 4 years experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding) preferred.
* Experience with computers including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records preferred.
* Familiarity with basic medical terminology and concepts used in care management preferred.
* Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm.
* Strong organizational skills, including effective verbal and written communication skills.
Bilingual (Spanish) preferred.
Education
The highest level of education desired for candidates in this position in a High School diploma, G.E.D. or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs - and for Aetna to keep its competitive edge.
The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members. Our Engagement Care Management Associates demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative. The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer. By successfully enrolling members into care management, further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness.
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 procedure/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.
Required Qualifications
* Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
* Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude.
* 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
* Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
* Works independently and competently, meting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically.
* Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Preferred Qualifications
* 2 - 4 years experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding) preferred.
* Experience with computers including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records preferred.
* Familiarity with basic medical terminology and concepts used in care management preferred.
* Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm.
* Strong organizational skills, including effective verbal and written communication skills.
Bilingual (Spanish) preferred.
Education
The highest level of education desired for candidates in this position in a High School diploma, G.E.D. or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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