Clinical Care Associate

Horizon Blue Cross Blue Shield of New Jersey • Full-time • Hopewell, NJ • 5d ago

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

This position is accountable for providing support to the field based Care Managers (RN II and Care Specialist III). In addition, Clinical Care Associates serve as the first point of contact for our members looking for service and/or provider information as well as members or providers requesting authorizations and denials of services. This position coordinates and secures health care services required as part of a member centric plan of care, under the direction and supervision of the Care Manager.

What You'll Do

Assist with scheduling and coordination of service needs identified in the members Plan of Care. The Clinical Care Associate works with the member to find health care professionals, locate and coordinate health and safety services, schedule appointments and services and provide authorizations and if appropriate, complete denials for care services.
Assist with all aspects of the implementation and facilitation of services.
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 placing 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.
Interacts with the CM member/family, physician and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed.
Utilizes care management process for goal directed member care.
Provides member with educational information to support their health and well-being.
Documents accurately and comprehensively based on the standards of practice and current organization policies.
Provides telephonic assistance for activities specific to the program. Troubleshoots and resolve issues for members as well as the field staff they support.
Professionally and adequately respond to queries from member and provider calls that are received CCA phone queue.
Mails required documents to members as well as upload returned documents into the medical management system, to meet contractual requirements.

What You Bring

Education/Experience:

High School Diploma/GED required.
Prefers healthcare industry experience.
Prefers 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 care managers, 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.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$56,200 - $75,285

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.