Care Management Associate

This is a fully remote position, open to applicants in Florida, +7 more states.

📋 Description

• Assist in the comprehensive coordination of the National Medical Excellence Program by managing inbound calls from the phone queue.

• Conduct call intake from both providers and members.

• Utilize Aetna systems, such as MedCompass, HRP, ASD, CEC, and ATV, to create, investigate, and input member information.

• Perform non-medical research tasks, including eligibility verification, coordination of benefits, and benefits confirmation.

• Ensure accurate documentation and compliance with risk management, regulatory, and accreditation standards.

• Process referrals, conduct outreach calls, and input data through telephone, fax, and EDI.

• Collaborate with clinical teams, medical directors, claims personnel, and contacting staff.

• Communicate with transplant financial coordinators, members, providers, Aetna nurses, and medical directors.

• Initiate authorizations for kidney transplants in accordance with unit protocols.

• Create shell cases for transplant, cellular therapy, and gene therapy requests and assign them for nurse evaluation.

• Foster internal and external communication to improve medical management services.

• Safeguard member confidentiality and adhere to company confidentiality policies.

• Assist in precertification administration while complying with relevant laws, regulations, NCQA standards, and company procedures.

• Engage in sedentary tasks that involve sitting, talking, hearing, and typing.

• Conduct close inspection of both handwritten and computer-generated documents.

• Perform additional responsibilities as assigned.

⛳️ Requirements

• A minimum of 2 years’ experience as a medical assistant, office assistant, or in a similar clinical role.

• Proficient computer skills, particularly in Microsoft Office Suite, with an emphasis on Excel.

• Capability to communicate effectively with diverse populations.

• Ability to collaborate and function well in a team setting.

• Flexibility and the ability to work independently.

• High School Diploma or equivalent GED is mandatory.

• Full-time commitment of 40 hours per week.

• Preferred: At least 1 year of prior insurance experience, ideally in a call center environment.

• Preferred: Experience in telephonic customer service.

• Preferred: A minimum of 1 year in prior authorization roles.

• An Associate Degree is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.