Clinical Care Associate

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Provide assistance to Care Managers in the field (RN II and Care Specialist III)

• Act as the initial contact for members seeking information regarding services or providers, as well as for members or providers requesting service authorizations and denials

• Arrange and coordinate service requirements outlined in members' Plans of Care

• Assist members in locating healthcare professionals and coordinating health and safety services

• Organize appointments and services, providing authorizations or processing denials as needed

• Implement and facilitate services while ensuring timely follow-up with members

• Communicate and engage with members during telephone interactions

• Promote member participation and adherence to the program

• Coordinate high-quality, cost-effective care tailored to member needs, aligned with the managed long-term support and services model

• Collaborate with members, families, physicians, and healthcare teams

• Establish priorities, plan, organize, and execute goal-directed interventions using the care management approach

• Provide educational resources that support member health and wellness

• Document information accurately and thoroughly in accordance with practice standards and organizational policies

• Offer telephonic support for activities specific to the program

• Address and resolve issues for members and field staff

• Respond to inquiries from members and providers received in the CCA phone queue

• Send necessary documents to members and upload returned materials into the medical management system

⛳️ Requirements

• High School Diploma or GED is required

• Experience in the healthcare industry is preferred

• At least one (1) year of experience in home care, discharge planning, or case management is preferred

• Experience with the elderly frail population is preferred

• Minimum of one (1) year experience in the managed care sector is preferred

• Understanding of care management standards, service coordination, and service delivery

• In-depth knowledge of managed care principles and concepts, including HEDIS

• Strong organizational abilities

• Excellent oral and written communication skills

• Proficient PC skills

• Familiarity with medical management systems for electronic medical records

• Capability to utilize Microsoft Office applications, including Excel, Access, and Word

• Strong problem-solving and conflict-resolution abilities

• Presentation skills

• Ability to work with minimal daily supervision

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous Paid Time Off (PTO)

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement