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

Posted in Other 25 days ago.





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.