PPP Clinical Care Associate

PPP Clinical Care Associate

Requirements

• 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.
• 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).

Responsibilities

• Assist with scheduling and coordination of service needs identified in the members Plan of Care.
• 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.

Preferred Qualifications

• 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.