Clinical Care Associate

Job not on LinkedIn

🕒 2 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $56.2k - $75.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Assist with scheduling and coordination of service needs identified in the members Plan of Care • Works 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 • Interacts and communicates effectively with the member during telephonic contact • Encourages member participation and compliance in the program • Assist with placing calls to members • Coordinates the delivery of high quality, cost-effective care based on the members' needs and the managed long-term support and services model supported by clinical practice guidelines established by the plan • Interacts with the CM member/family, physician and healthcare team • Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed • Provides member with educational information to support their health and well-being • Documents accurately and comprehensively based on the standards of practice and current organization policies • Provides telephonic assistance for activities specific to the program • Troubleshoots and resolve issues for members as well as the field staff they support • Professionally and adequately respond to queries from member and provider calls that are received CCA phone queue • Mails required documents to members as well as 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)

🏖️ Benefits

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