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Care Planner position would work within the Commercial and IFP membership of the Behavioral Health Division of Aetna/CVS. Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews

The Care Planner would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.

Additional responsibilities to include but limited to the following:

– Provide service to clinical teams in support of optimal care.
– Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.
– Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.
– Schedules and coordinates appointments between providers or attending physicians and Aetna Medical Directors or Consultants.
– Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.
– Complies with state mandated and Aetna regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.

Required Qualifications

– 2 plus years experience in health insurance field or
– 2 plus years Administrative/ Secretarial experience or
– 2 plus years Customer service experience within health care or a mental health capacity
– Ability to type 60-70 words per minute

– Demonstrated knowledge and experience using Microsoft Office Suite, including: Outlook, Word, and Excel

Preferred Qualifications

– Good organizational skills
– A go-getter who works independently
– Excellent communication

Behavioral Health Care Planner

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