Care Coordination Specialist II — Case Management & Liaison

Embedded Shishya; United States; Remote; USD 50,000 - 67,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a Clinical Operations Coordinator to support non-clinical teams and manage escalated issues across members, physicians, and care managers. You will help collect data, coordinate case management, and assist with provider communications to ensure appropriate benefits and treatment plans.

Responsibilities include onboarding new coordinators, handling referrals, and ensuring accurate documentation in both English and Spanish.

Qualifications

• High School Diploma or GED required.
• 3-5 years of customer service experience.
• Knowledge of medical terminology.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Operational knowledge of health care delivery systems.
• Knowledge of NCQA accreditation standards and state/federal health plan laws (CMS/state regulations).

Responsibilities

• Review service requests for completeness and data transfer.
• Route cases for clinical review.
• Coordinate benefits and treatment plans with providers.
• Assist onboarding and training of Managed Care Coordinators.
• Triage referrals from Member Services and providers.
• Translate clinical and non-clinical documents between English and Spanish.

Skills

Team Player

Analytical skills

Interpersonal skills

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a Clinical Operations Coordinator to support non-clinical teams and manage escalated issues across members, physicians, and care managers. You will help collect data, coordinate case management, and assist with provider communications to ensure appropriate benefits and treatment plans.

Responsibilities include onboarding new coordinators, handling referrals, and ensuring accurate documentation in both English and Spanish.