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H
Clinical Care Associate, LPN
Horizon Connect @ Wall BCBSNJ. Provide support to field based Care Managers (RN II and Care Specialist III).
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coordinating healthcare services and managing member-centric care plans, with strong knowledge of managed care principles and effective communication skills. Proficient in utilizing medical management systems and Microsoft Office applications to support care delivery and documentation.
Highest-signal resume keywords
Healthcare CoordinationManaged Care PrinciplesOral And Written Communication SkillsProblem SolvingOrganizational Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care CoordinationCase ManagementDischarge PlanningKnowledge Of HEDISMedical Management System Proficiency
Soft Skills
Conflict ResolutionPresentation SkillsMember Engagement
Tools & Technologies
Microsoft OfficeElectronic Medical Records
Industry Keywords
Healthcare Industry ExperienceManaged Care Industry ExperienceElderly Frail Population
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement