Care Manager I — Specialty Programs & Care Coordination

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 71,000 - 94,000; 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 Care Manager I - Specialty Programs to perform care coordination using established guidelines and plan for transitions to the continuum of care for specialty populations. The role focuses on ensuring appropriate care levels and efficient utilization of benefits.

The role requires RN licensure or a BA in social work/health/behavioral science with at least 3 years of experience serving members with special needs.

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.
• Requires a minimum of three (3) years' experience serving members with special needs.

Responsibilities

• Assess member's clinical need against guidelines and standards for specialty population-based members.
• Implement delivery of high quality, cost-effective care based on a customized population model of care with clinical guidelines.
• Partner with member/family, physician, and healthcare team to meet member needs and coordinate resource utilization.
• Use care management process to set priorities, plan, organize, and implement interventions toward self-care and transition to independence.
• Monitor care for mandated non-compliant members and utilization.
• Document accurately per standards of practice and policies.
• Evaluate care by problem solving, analyzing variances, and participating in quality improvement.
• Monitor member care activities and outcomes for appropriateness and effectiveness.
• Consult with internal stakeholders on complex cases and escalate to internal physician resources.
• Complete other assigned functions as requested by management.

Skills

Organizational skills

Oral and written communication

Problem solving

Driving - NJ license & insurance

Education

RN license or BA in social work/health/behavioral science

Graduate degree in Social Work or Health & Behavioral Science preferred

Tools

Microsoft Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to perform care coordination using established guidelines and plan for transitions to the continuum of care for specialty populations. The role focuses on ensuring appropriate care levels and efficient utilization of benefits.

The role requires RN licensure or a BA in social work/health/behavioral science with at least 3 years of experience serving members with special needs.