Care Manager I, Specialty Programs (Morris/Sussex/Warren Counties)

100 Horizon Healthcare Services, Inc; Hopewell (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I for Specialty Programs in New Jersey. The role focuses on care coordination, transitioning members to the continuum of care, and ensuring appropriate utilization of benefits. Requires RN license or BA in social work/health.

Three years of relevant experience preferred, with strong MS Office skills. The position emphasizes collaboration with physicians and care teams to deliver high-quality, cost-effective care and to

Qualifications

• Requires RN license, or Bachelor degree in social work, health or behavioral science. Graduate level degree preferred.
• Minimum of three years’ experience serving members with special needs.

Responsibilities

• Assess member’s clinical need against guidelines for specialty population-based members.
• Implement delivery of high quality, cost-effective care.
• Coordinate with member, family, physician and healthcare team to meet needs.

Skills

Organizational skills

Communication

Problem solving

Microsoft Office

Education

RN license

Bachelor degree in Social Work/Health/Behav. Science

Tools

Excel

Access

Word

Job description

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.

About the Role

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.

What You'll Do

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 elevate as appropriate to internal physician resources. Complete other assigned functions as requested by management.

What You Bring 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.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives—while being supported by a mission-driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range

$70,500 - $94,395

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer

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

About Us

We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too.

Our Mission

We empower our members to achieve their best health.

Our Vision

We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.