[Hiring] Clinical Care Associate @Horizon Blue Cross Blue Shield of New Jersey

Role Description

This position is accountable for providing support to the field based Care Managers (RN II and Care Specialist III). In addition, Clinical Care Associates serve as the first point of contact for our members looking for service and/or provider information as well as members or providers requesting authorizations and denials of services. This position coordinates and secures health care services required as part of a member centric plan of care, under the direction and supervision of the Care Manager.

• Assist with scheduling and coordination of service needs identified in the members Plan of Care.
• Work with the member to find health care professionals, locate and coordinate health and safety services, schedule appointments and services, and provide authorizations and if appropriate, complete denials for care services.
• Assist with all aspects of the implementation and facilitation of services.
• Ensure timely member follow up and interact effectively with the member during telephonic contact.
• Encourage member participation and compliance in the program.
• Place calls to members and coordinate the delivery of high quality, cost-effective care based on the members' needs.
• Interact with the CM member/family, physician, and healthcare team.
• Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed.
• Provide members with educational information to support their health and well-being.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Provide telephonic assistance for activities specific to the program and troubleshoot issues for members and field staff.
• Respond professionally to queries from member and provider calls received in the CCA phone queue.
• Mail required documents to members and upload returned documents into the medical management system to meet contractual requirements.

Qualifications

• High School Diploma/GED required.
• Prefers healthcare industry experience.
• Prefers a minimum of one (1) year experience in home care, discharge planning, or case management, preferably with the elderly frail population.
• Prefer a minimum of one (1) year experience in the managed care industry.

Requirements

• Requires knowledge of the standards of practice for care managers, coordination of services, and delivery of services.
• Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS).
• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills, knowledge of working with a Medical Management system for electronic medical records, and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Requires good problem solving and conflict resolution skills.
• Requires good presentation skills.
• Requires ability to work with limited daily supervision.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement