MLTSS Clinical Care Coordinator

Horizon Blue Cross Blue Shield of New Jersey – Hopewell, NJ

This position is accountable for assisting and extending support to the MLTSS RN/MLTSS Care Specialist working in the field. This position supports members based in the Community, Group Homes, Assisted Living and Long Term Care settings. 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 Care Management appointments and scheduling.
  • Assist with scheduling and coordination of Service needs identified in the member-s Plan of Care. Assist with implementation and facilitation of services for managed long term support and services care members.
  • Ensure timely member follow up. Interacts and communicates effectively with the managed long term support and services member during telephonic contact.
  • Encourages member participation and compliance in the managed long term care support and services care management program efforts.
  • 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.
  • Collaborates with the long term care member/family, physician and all members of the healthcare team, internal and external to this organization.
  • Advocates for the managed long term support and services member/family among various sites to coordinate resource utilization and evaluation of services provided
  • .Interacts with the managed long term care support and services member/family, physician and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed.
  • Utilizes managed long term care support and services care management process for goal directed member care.
  • Documents accurately and comprehensively based on the standards of practice and current organization policies.
  • Understands fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self-care outcomes.
  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance long term care member outcomes.
  • Provides telephonic care management assistance for activities specific to the managed long term support and services case management program.
  • Performs duties as assigned by management.
  • Education/Experience

  • Prefers an Associate or Bachelor s degree from an accredited college or university.
  • Requires a minimum of one (1) to two (2) years broad clinical 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.
  • Additional licensing, certifications, registrationsKnowledge

  • 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 Employer 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.
  • 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.

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