Clinical Care Associate

Job not on LinkedIn

🔥 0 minutes 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

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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 or provider information and for members or providers requesting authorizations and denials of services • Schedule and coordinate service needs identified in members' Plans of Care • Help members find healthcare professionals and coordinate health and safety services • Schedule appointments and services and provide authorizations or complete denials when appropriate • Implement and facilitate services and ensure timely member follow-up • Interact and communicate with members during telephonic contact • Encourage member participation and compliance in the program • Coordinate high-quality, cost-effective care based on member needs and the managed long-term support and services model • Interact with members, families, physicians, and healthcare teams • Set priorities, plan, organize, and implement goal-directed interventions using the care management process • Provide educational information supporting member health and well-being • Document accurately and comprehensively according to standards of practice and organizational policies • Provide telephonic assistance for program-specific activities • Troubleshoot and resolve 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

🎯 Requirements

• High School Diploma/GED required • Healthcare industry experience preferred • Minimum of one (1) year experience in home care, discharge planning, or case management preferred • Experience with the elderly frail population preferred • Minimum of one (1) year experience in the managed care industry preferred • Knowledge of standards of practice for care managers, coordination of services, and delivery of services • Strong knowledge of managed care principles and concepts, including HEDIS • Strong organizational skills • Strong oral and written communication skills • Good PC skills • Knowledge of medical management systems for electronic medical records • Ability to use Microsoft Office applications, including Excel, Access, and Word • Problem-solving and conflict-resolution skills • Presentation skills • Ability to work with limited daily supervision • Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

🏖️ Benefits

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