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LTC Enrollment Specialist

Company: Wellcare Health Plans
Location: Newark
Posted on: November 12, 2019

Job Description:

WellCare is currently hiring a LTC Enrollment Specialist to cover the following counties Cumberland, Camden, Burlington, Mercer, Gloucester. This position is 80% Field work.Assess applicants in the community for eligibility and enrollment in our Managed Long Term Care program. Provides overview of program's benefits to applicant, family member(s), care giver(s). Complete medical assessment of applicant and develop personalized plans of care. Complete Reassessment as needed of our members in the Managed Long term Care Program.Reports to: Sup. Clinical CareDepartment: NJ Care ManagementLocation: Newark, New JerseyEssential Functions:Conduct home visit(s) to educate applicant, family and/or applicant's caregiver(s) on program benefits and design.Identify applicant's health needs and complete medical assessment of applicant.Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care.Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care.Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver.Collect information concerning eligibility, provider status, benefit coverage, and coordination of benefits.Input visit and assessment data into systems.Adhere to all HIPPA standards and confidentiality requirements.Performs other duties as assigned.Additional Responsibilities:Valid Drivers license may be requiredConduct home visit(s) to educate applicant, family and/or applicant's caregiver(s) on program benefits and design.Identify applicant's health needs and complete medical assessment of applicant.Utilize WellCare designated criteria along with clinical knowledge to develop personalized plan of care.Initiate direct communication with health care providers involved in the care of the applicant to obtain complete and accurate information needed to complete plan of care.Negotiate appropriate care plan based on health assessments with health care providers, member and caregiver.Collect information concerning eligibility, provider status, benefit coverage, and coordination of benefits.Input visit and assessment data into systems.Adhere to all HIPPA standards and confidentiality requirements.Performs other duties as assigned.Candidate Education:Required An Associate's Degree in Nursing Preferred A Bachelor's Degree in Nursing or related fieldCandidate Experience:Required 4 years of experience in A clinical acute care setting, preferably in home health and/or geriatrics.Required Other Current case management experiencePreferred Other Public speaking and health education experience Candidate Skills:Intermediate Knowledge of healthcare deliveryIntermediate Ability to effectively present information and respond to questions from families, members, and providersIntermediate Ability to effectively present information and respond to questions from peers and managementIntermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusionsIntermediate Ability to influence internal and external constituentsIntermediate Ability to represent the company with external constituentsIntermediate Demonstrated customer service skillsIntermediate Ability to create, review and interpret treatment plansIntermediate Demonstrated interpersonal/verbal communication skillsIntermediate Demonstrated written communication skills Licenses and Certifications:A license in one of the following is required:Required Licensed Registered Nurse (RN)Preferred NJ Choice Certification Technical Skills:Required Intermediate Microsoft ExcelRequired Intermediate Microsoft OutlookRequired Intermediate Microsoft WordRequired Intermediate Healthcare Management Systems (Generic) Languages:Preferred Other Bilingual skillsAbout usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Newark , LTC Enrollment Specialist, Other , Newark, New Jersey

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