Clinical Care Associate - LPN

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

2d•$56,200 - $75,285

About The Position

The Clinical Care Associate (LPN) supports field-based Care Managers (RN II and Care Specialist III) and serves as a first point of contact for members seeking service or provider information, and for members or providers requesting service authorizations or denials. Under the direction and supervision of a Care Manager, the role coordinates and secures healthcare services as part of a member-centered plan of care. The position also provides telephonic assistance, helps resolve issues for members and field staff, and supports documentation and program requirements. The role requires a high school diploma or GED. Healthcare industry experience is preferred, as is at least one year of experience in home care, discharge planning, or case management—preferably with an elderly frail population—and at least one year of managed care industry experience. Candidates should understand care management practice standards, service coordination and delivery, managed care principles, and HEDIS. Strong organizational, communication, problem-solving, conflict-resolution, presentation, and computer skills are required, including experience with electronic medical record systems and Microsoft Office applications. The ability to work with limited daily supervision is also required. The salary range is $56,200–$75,285. Horizon offers a comprehensive compensation and benefits package. Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

High school diploma or GED.
Knowledge of care manager standards of practice and the coordination and delivery of services.
Strong knowledge of managed care principles and concepts, including Health Plan Effectiveness Data and Information Sheet (HEDIS).
Strong organizational skills.
Strong oral and written communication skills.
Good PC skills, knowledge of electronic medical record medical management systems, and ability to use Microsoft Office applications such as Excel, Access, and Word.
Good problem-solving and conflict-resolution skills.
Good presentation skills.
Ability to work with limited daily supervision.

Nice To Haves

Healthcare industry experience.
At least one year of experience in home care, discharge planning, or case management, preferably with the elderly frail population.
At least one year of experience in the managed care industry.

Responsibilities

Assist with scheduling and coordinating service needs identified in members’ plans of care, including locating healthcare professionals and coordinating health and safety services.
Schedule appointments and services, provide authorizations, and, when appropriate, complete denials for care services.
Assist with all aspects of implementing and facilitating services.
Ensure timely member follow-up and communicate effectively with members by telephone.
Encourage member participation and compliance in the program.
Assist with placing calls to members and coordinate high-quality, cost-effective care based on member needs and the managed long-term support and services model and clinical practice guidelines.
Interact with the Care Manager, member and family, physicians, and healthcare team; use the care management process to prioritize, plan, organize, and implement goal-directed interventions.
Provide members with educational information to support their health and well-being.
Document accurately and comprehensively according to standards of practice and current organizational policies.
Provide telephonic assistance for program-specific activities and troubleshoot and resolve issues for members and field staff.
Respond professionally and adequately to member and provider queries received through the CCA phone queue.
Mail required documents to members and upload returned documents into the medical management system to meet contractual requirements.