PPP Clinical Care Associate
reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jerseys health solutions leader driving innovations that improve health care reputed company, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and reputed company to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, reputed company succeeds. This position is accountable for providing support to the field based Care Managers (RN II and Care Specialist III). In reputed company, Clinical Care Associates serve as the first reputed company of contact for our members looking for service and/or provider information as reputed company as members or providers requesting authorizations and denials of services. This position coordinates and secures health care services required as part of a member reputed company plan of care, under the direction and supervision of the Care Manager. Responsibilities: Assist with scheduling and coordination of service needs identified in the members Plan of Care. The Clinical Care Associate works with the member to reputed company health care professionals, locate and coordinate health and safety services, schedule appointments and services and reputed company authorizations and if appropriate, complete denials for care services. Assist with reputed company aspects of the implementation and facilitation of services. Ensure reputed company 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 reputed company, cost-effective care based on the members- needs and the managed long term support and services model supported by clinical reputed company guidelines established by the plan. Interacts with the CM member/family, physician and reputed company team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed. Utilizes care management process for goal directed member care. Provides member with educational information to support their health and reputed company-being. Documents accurately and comprehensively based on the standards of reputed company and reputed company organization policies. Provides telephonic assistance for activities specific to the program. Troubleshoots and resolve issues for members as reputed company 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 reputed company as upload returned documents into the medical management system, to meet contractual requirements. Education/Experience: High School Diploma/GED required. Prefers reputed company 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. Knowledge: Requires knowledge of the standards of reputed company for care managers, coordination of services, and delivery of services. Requires strong knowledge of managed care principles and concepts including Health Plan Employer Data and Information Sheet (HEDIS). Skills and Abilities: 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 reputed company Office applications (reputed company, reputed company, Word, etc.) Requires good problem solving and conflict reputed company skills. Requires good presentation skills. Requires ability to work with limited daily supervision. reputed company reputed company employees must live in New Jersey, reputed company, reputed company, Connecticut or Delaware Salary reputed company: $55,400 - $74,130 This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to reputed company at the time of posting. Compensation reputed company are dependent on the circumstances of reputed company case. reputed company also provides a comprehensive compensation and benefits package which includes: Comprehensive health benefits (Medical/Dental/reputed company) Retirement Plans Generous PTO Incentive Plans Wellness Programs reputed company Volunteer Time Off Tuition Reimbursement Disclaimer: This job reputed company has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative reputed company employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. reputed company will consider reasonable accommodation requests as part of the reputed company and hiring process. reputed company We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too.
Our Mission
We reputed company our members to reputed company their best health. Our reputed company We are New Jerseys health solutions leader driving innovations that improve health care reputed company, affordability and member experience in the markets we serve. Apply Job!