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Long Term Care (LTC) Enrollment Specialist - New York

Company: Wellcare
Location: New York
Posted on: January 14, 2018

Job Description:

Assess applicants in the community for eligibilityand 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.Department: LTC
ProgramsReports to:
Sr Mgr, LTC ProgramsEssential
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
requiredCandidate
Education:Required An
Associate's Degree in NursingPreferred 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
experienceCandidate
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 skillsLicenses
and Certifications:A license in one of
the following is required:Required
Licensed Registered Nurse
(RN)Technical
Skills:Required Intermediate
Microsoft ExcelRequired Intermediate Microsoft
OutlookRequired Intermediate Microsoft
WordRequired Intermediate Healthcare
Management Systems
(Generic)Languages:Preferred
Other Bilingual skills

Keywords: Wellcare, New York, Long Term Care (LTC) Enrollment Specialist - New York, Other, New York, New York

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