Care Manager Associate
$38,480–$73,403 year
RemoteUnited States
Job Summary
Review and triage Care Team tasks, identifying admission reasons and applying intervention assessment tools to coordinate required medical services. Screen patients using targeted business rules to make referrals, monitor non-targeted cases for discharge disposition, and refer outlier cases to clinical staff. Utilize eTUMS and Aetna systems to build member information, support care plan development, and arrange service delivery under nurse or medical director direction. Perform non-medical research for case establishment and closure, resolve claims payment issues, and maintain accurate documentation meeting regulatory and accreditation standards. Adhere to compliance policies, protect member confidentiality, and provide administrative support by answering calls and solving team problems.
Required Qualifications
- Minimum of 1-3+ years of experience in customer service, healthcare support, medical office, call center, care coordination, or another member-facing role.
- Demonstrated ability to deliver exceptional service to members, patients, customers, or providers by actively listening, assessing needs, and providing timely, accurate solutions.
- Experience managing member inquiries, resolving service-related issues, and coordinating with internal and external partners to achieve positive outcomes.
- Strong interpersonal, communication, and problem-solving skills with a commitment to member satisfaction and service excellence.
- Ability to navigate sensitive situations with empathy, professionalism, and a member-first approach.
- Proficiency with Microsoft Outlook, Word, Excel, and other technology tools used to support member communications, documentation, case tracking, and issue resolution.
- High School diploma, G.E.D. or equivalent experience
Desired Qualifications
- Experience supporting health plan members, patients, providers, or customers in a healthcare, insurance, or service-focused environment.
- Demonstrated ability to collaborate across departments and provider networks to resolve complex member or customer issues.
- Experience identifying opportunities to improve service delivery and enhance the overall member experience.
- Ability to manage multiple priorities in a fast-paced environment while maintaining a high level of customer service.
- Knowledge of healthcare benefits, insurance processes, medical terminology, or provider office operations.
- Experience using technology and case management systems to document interactions, track issues, and support service resolution.
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