Care Coordination Specialist – Managed Care

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 45,000 - 60,000; 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 is seeking a detail-focused professional to support Clinical Operations. The role acts as a liaison among Members, Physicians, Delegates, and Care Managers to coordinate services and benefits.

Responsibilities include reviewing requests, documenting cases, performing case management activities, and ensuring timely communication with providers and members. Knowledge of Medicaid CM is preferred, with strong analytical and interpersonal skills.

Qualifications

• Knowledge of medical terminology is required.
• Good oral and written communication skills.
• Ability to make sound decisions under supervision.
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing.
• Prefer knowledge Managed Care principles.
• Prefer ability to analyze and resolve problems with minimal supervision.
• Prefer ability to use a PC and applicable software and systems.

Responsibilities

• Review service requests for completeness and data transfer.
• Coordinate with members, physicians, delegates and care managers.
• Route cases for clinical review and coordinate benefits.
• Support utilization management screening and pre-certification.
• Assist members with finding providers and resolving issues.
• Review and respond to medical, dental, and vision claims.

Skills

Medical terminology

Oral & written communication

Sound decision making

Managed Care principles

PC/Software literacy

Team player

Analytical skills

Interpersonal skills

Contracts & enrollment

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a detail-focused professional to support Clinical Operations. The role acts as a liaison among Members, Physicians, Delegates, and Care Managers to coordinate services and benefits.

Responsibilities include reviewing requests, documenting cases, performing case management activities, and ensuring timely communication with providers and members. Knowledge of Medicaid CM is preferred, with strong analytical and interpersonal skills.