Care Manager I, Specialty Programs

Horizon Blue Cross Blue Shield of New Jersey; Brasil; Teletrabalho; BRL 372.000 - 499.000; Tempo integral

Resumo da oferta

A healthcare insurance provider is seeking a Care Manager I to coordinate care for specialty populations. The role requires strong organizational and communication skills, with a focus on quality, cost-effective care. Candidates should possess an RN license or relevant bachelor’s degree, along with at least three years of experience with special needs populations. The position offers a salary range of $69,500 - $93,030 along with comprehensive health benefits and a retirement plan.

Serviços

Comprehensive health benefits (Medical/Dental/Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Qualificações

• Requires a minimum of three years’ experience serving members with special needs.
• Strong knowledge of managed care principles.
• Knowledge of specialty population as applicable.

Responsabilidades

• Assess member’s clinical need against established guidelines.
• Implement high quality, cost-effective care.
• Partner with physician and the healthcare team to meet member’s needs.
• Utilize care management process for goal-directed interventions.
• Document accurately based on standards of practice.
• Evaluate care through problem-solving and quality improvement.

Conhecimentos

Strong organizational skills

Strong oral and written communication skills

Good PC skills (Excel, Access, Word)

Good problem solving and conflict resolution skills

Formação académica

License as an RN or Bachelor's degree in social work, health or behavioral science

Graduate level degree in Social Work or Health and Behavioral Science preferred

Ferramentas

Microsoft Office applications

Descrição da oferta de emprego

Overview

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

The Care Manager I – Specialty Programs is responsible for performing care coordination duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care for specialty populations. This position implements interventions to ensure efficient utilization of benefits.

Responsibilities

• Assess member’s clinical need against established guidelines and/or standards for specialty population-based members.
• Implement the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan.
• Partner with the member/family, physician, and all members of the healthcare team to ensure the member’s needs are met, internal and external to this organization. Advocate for the member among various sites to coordinate resource utilization.
• Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status.
• Ensure care for mandated non-compliant members through the monitoring of utilization.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes.
• Monitor member’s care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness.
• Consult with internal stakeholders on complex cases and escalate as appropriate to internal physician resources.
• Complete other assigned functions as requested by management.

Education/Experience

• Requires a license as an RN, or Bachelor degree in social work, health or behavioral science.
• Graduate level degree in Social Work or Health and Behavioral Science preferred.
• Requires a minimum of three (3) years’ experience serving members with special needs.

Knowledge

• Requires strong knowledge of the standards of practice for case managers.
• Requires strong knowledge of managed care principles.
• Requires strong knowledge of specialty population, as applicable.

Skills and Abilities

• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Requires good problem solving and conflict resolution skills.
• Requires a car with valid New Jersey State License and Insurance for certain positions.

Residency

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range

$69,500 - $93,030

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer

Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Equal Opportunity

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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.