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Clinical Care Specialist

2 months ago

Jersey City, New Jersey, United States Fidelis Care Full time
Job Summary

We are seeking a skilled Clinical Care Specialist to join our Medical Management/Health Services team. As a key member of our team, you will play a critical role in ensuring our members receive high-quality care and support.

Key Responsibilities
  • Conduct home visits to educate applicants, families, and caregivers on program benefits and design.
  • Identify applicants' health needs and complete medical assessments.
  • Develop personalized plans of care using WellCare designated criteria and clinical knowledge.
  • Negotiate care plans with healthcare providers, members, and caregivers.
  • Collect information on eligibility, provider status, benefit coverage, and coordination of benefits.
  • Input visit and assessment data into systems.
  • Adhere to HIPAA standards and confidentiality requirements.
  • Transition members to assigned care managers as needed.
Requirements
  • Reside in Hudson County, NJ.
  • Hold an Associate's Degree in Nursing.
  • Have 4+ years of experience in a clinical acute care setting, preferably in home health and/or geriatrics.
  • Be a Licensed Registered Nurse (RN).
What We Offer

We offer a comprehensive benefits package, including competitive pay, health insurance, 401K, and stock purchase plans. Our flexible work approach allows for remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on individual skills, experience, education, and other job-related factors permitted by law.

We are an equal opportunity employer committed to diversity and value the unique perspectives of our employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.