Care Management Associate (Must reside in Jefferson County, KY)

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Position Summary

The Care Management Associate supports comprehensive coordination of medical services including care team intake, screening, and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes and supports quality effectiveness of healthcare services.

This is a telework position and qualified candidates must reside in Jefferson County, KY. Some travel (5%-10%) may be required to the Louisville office for meetings and trainings.

Fundamental Components

• Responsible for initial review and triage of care team tasks.
• Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
• Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services in accordance with the benefit plan.
• Monitors non-targeted cases for entry of appropriate discharge date and disposition.
• Identifies and refers outlier cases (e.g., length of stay) to clinical staff.
• Identifies triggers for referral into Aetna's case management, disease management, mixed services, and other specialty programs.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Supports the development and implementation of care plans.
• Coordinates and arranges for health care service delivery under the direction of nurse or medical director, in the most appropriate setting at the most appropriate expense, by identifying opportunities for the patient to utilize participating providers 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 PM policies and 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.
• May assist in the research and resolution of claims payment issues.
• Supports the administration of the hospital care, case management, and quality management processes in compliance with various laws and regulations, URAQ and/or National Committee for Quality Assurance (NCQA) standards, and Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.

Required Qualifications

• 2-4 years of experience in the foster care and juvenile justice systems, adoption assistance, the delivery of behavior health services, trauma-informed care, ACEs, crisis intervention services, and evidence-based practices applicable to the Kentucky SKY populations.
• 2+ years of experience with Microsoft Office, including Outlook, Word, Excel, PowerPoint, and Teams. Effective communication, telephonic and organization skills.
• Must reside within Jefferson County, KY.
• Ability to travel up to 10% of the time within Jefferson County, KY.

Preferred Qualifications

• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and reso