Support comprehensive coordination of medical services including Navigation
Center Team intake, screening, assignment of cases, interactions with external
vendors/services, and member outreach to promote effective program/operational
* Supports Texas Health | Aetna’s mission and values while promoting a positive culture
* Responsible for initial review and triage of Nav Center tasks.
* 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 eligibility and benefit plan.
* Identifies triggers for referral into the Navigation Center and other Specialty Programs utilizing systems and reports
* Utilizes ATV and other Aetna systems to build, research and enter member information, as needed.
* May coordinate and arrange for health care service delivery or referral into care management services under the direction of nurse, Supervisor or Medical Director
* Assists Supervisor/manager in coordinating, scheduling, and communicating re Team meetings to impacted staff
* Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively)
* 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 Regulatory Standards.
* Maintains accurate and complete documentation of required information that meets risk management, regulatory, and other requirements.
* Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
2-4 years experience as a medical assistant, office assistant. High School
Diploma or G.E.D.
Bilingual (Spanish/English) preferred
Strong proficiency with Microsoft Office Suite (Word, Excel, PowerPoint,
Computer literacy in order to navigate through other internal/external
Additional Job Information:
Effective communication, telephonic and organization skills.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 resolution of
issues to promote positive outcomes for members.Computer literacy in order to
navigate through internal/external computer systems, including Excel and
Microsoft Word.Ability to effectively participate in a multi-disciplinary team
including internal and external participants.
Potential Telework Position:
Percent of Travel Required:
0 – 10%
Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit eligibility may vary by position.
Candidate Privacy Information:
Aetna takes our candidate’s data privacy seriously. At no time will any Aetna
recruiter or employee request any financial or personal information (Social
Security Number, Credit card information for direct deposit, etc.) from you
via e-mail. Any requests for information will be discussed prior and will be
conducted through a secure website provided by the recruiter. Should you be
asked for such information, please notify us immediately.