Support 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/supports quality effectiveness of Healthcare Services.
- 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 eTUMS and other Aetna systems to build, research and enter member information, as needed.
- Support 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
- 2-4 years experience in the Medical field.
- High School Diploma or G.E.D.
Vacancy Type: Full Time
Job Location: Norfolk, VA, US
Application Deadline: N/A