Clinical Care Associate, LPN

Job not on LinkedIn

🔥 12 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $56.2k - $75.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 17%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Provide support to field based Care Managers (RN II and Care Specialist III). • Serve as the first point of contact for members seeking service and/or provider information and for members or providers requesting authorizations and denials of services. • Coordinate and secure 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 members’ Plans of Care. • Find health care professionals, locate and coordinate health and safety services, schedule appointments and services, and provide authorizations or complete denials for care services when appropriate. • Assist with implementation and facilitation of services. • Ensure timely member follow-up and communicate effectively with members during telephonic contact. • Encourage member participation and compliance in the program. • Coordinate delivery of high-quality, cost-effective care based on members’ needs and the managed long-term support and services model. • Interact with Care Manager members/families, physicians, and healthcare teams to plan and implement goal-directed interventions. • Provide educational information supporting member health and well-being. • Document accurately and comprehensively according to standards of practice and organizational policies. • Provide telephonic program assistance and troubleshoot issues for members and field staff. • Respond to member and provider queries received in the CCA phone queue. • Mail required documents to members and upload returned documents into the medical management system to meet contractual requirements.

🎯 Requirements

• 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. • 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

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