Care Manager I (RN/BSW) — Specialty Programs

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Health benefits

401(k) retirement

Generous PTO

Incentive plans

Wellness programs

Tuition reimbursement

Volunteer time off

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations and ensure appropriate utilization of benefits. You will work with members, families, physicians and the care team to optimize outcomes.

The role requires an RN license (or related BA) with at least three years in care management, and a preference for a graduate degree in social work or health/science.

Qualifications

• 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.
• Minimum of three (3) years' experience serving members with special needs.

Responsibilities

• Assess member's clinical need against guidelines for specialty population-based members.
• Implement high quality, cost-effective care based on a population model.
• Partner with the member, physician and healthcare team to coordinate resource utilization.
• Utilize care management to plan, organize and implement self-care and transitions.
• Monitor mandated non-compliant members' utilization and care.
• Document accurately based on standards and policies.
• Evaluate care and participate in quality improvement to improve outcomes.
• Monitor care activities across sites and networks for effectiveness.
• Consult with internal stakeholders on complex cases and escalate when needed.
• Complete other functions as requested by management.

Skills

RN license

Strong communication

PC skills

Car ownership

Education

RN license or Bachelor's in social work/health/behavioral science

Graduate degree in Social Work or Health and Behavioral Science preferred

Tools

Microsoft Office (Excel/Access/Word)

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations and ensure appropriate utilization of benefits. You will work with members, families, physicians and the care team to optimize outcomes.

The role requires an RN license (or related BA) with at least three years in care management, and a preference for a graduate degree in social work or health/science.