Clinical Care Coordinator at Horizon Blue Cross Blue Shield of New Jersey in Hopewell, New Jersey

Job Description:

Job Summary:

This position is accountable for assisting and extending support to the field based Care Managers and RN I. This position also
ensures facilitation of health care services within a member centric plan of care, under the direction and supervision of an RN.

Responsibilities:

• Will ensure timely appointments and scheduling.


• Assist with implementation and facilitation of services members.


• 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 all 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.


• Run reports to monitor compliance on scheduled services to ensure timely delivery of services and required follow up.


• Utilizes care management process for goal directed member care.


• Documents accurately and comprehensively based on the standards of practice and current organization policies.


• .Provides telephonic assistance for activities specific to the program.

Qualifications:

Education/Experience:

• Requires a High School diploma or GED. Associates or Bachelors degree from an accredited college or university preferred.


• Prefers healthcare industry experience.


• Requires 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 practice for, 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).

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 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.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position.

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