Clinical Care Associate, LPN

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

📋 Description

• Offer assistance to field-based Care Managers (RN II and Care Specialist III).

• Act as the primary contact for members seeking service or provider information, as well as for members or providers requesting authorizations and denials of services.

• Organize and secure necessary health care services as part of a member-focused care plan under the guidance and supervision of the Care Manager.

• Aid in the scheduling and coordination of service requirements identified in members’ Plans of Care.

• Identify healthcare professionals, locate and coordinate health and safety services, arrange appointments and services, and provide authorizations or complete denials for care services when necessary.

• Support the implementation and facilitation of services.

• Ensure timely follow-up with members and communicate effectively with them during telephone interactions.

• Foster member involvement and adherence to the program.

• Coordinate the delivery of high-quality, cost-efficient care tailored to members’ needs and the managed long-term support and services model.

• Collaborate with Care Manager members/families, physicians, and healthcare teams to plan and execute goal-oriented interventions.

• Supply educational resources promoting member health and well-being.

• Maintain accurate and thorough documentation in accordance with standards of practice and organizational policies.

• Provide telephonic program support and address 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 documents into the medical management system to fulfill contractual obligations.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• Prior experience in the healthcare industry is preferred.

• A minimum of one (1) year of experience in home care, discharge planning, or case management is preferred, particularly with the elderly frail population.

• At least one (1) year of experience in the managed care industry is preferred.

• Knowledge of care managers' standards of practice, service coordination, and service delivery is required.

• Strong understanding of managed care principles and concepts, including Health Plan Effectiveness Data and Information Sheet (HEDIS), is necessary.

• Excellent organizational skills are required.

• Strong oral and written communication abilities are essential.

• Proficiency in PC skills, familiarity with a Medical Management system for electronic medical records, and the ability to use Microsoft Office applications (Excel, Access, Word, etc.) are required.

• Good problem-solving and conflict resolution skills are necessary.

• Strong presentation skills are required.

• Ability to work with minimal daily supervision is essential.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement