Care Manager, Specialty Programs - Coordinated Care & Advocacy

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

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 for specialty populations. The role ensures appropriate care levels and plans transitions across the continuum of care, guided by plan-based clinical practice guidelines.

The candidate will partner with members, families, physicians, and the healthcare team to meet needs, monitor utilization, and document activities accurately.

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 years' experience serving members with special needs.

Responsibilities

• Assess member's clinical needs against guidelines for specialty population-based members.
• Implement high quality, cost-effective care based on a population model of care.
• Collaborate with member/family, physicians, and healthcare team to meet needs and coordinate resources.
• Use care management process to plan, organize and implement interventions toward self-care and transition to independence.
• Monitor utilization to ensure care for mandated non-compliant members.
• Document accurately per standards of practice and policies.
• Evaluate care through problem solving and quality improvement.
• Monitor care activities across sites and networks for appropriateness and outcomes.
• Consult with internal stakeholders on complex cases and elevate to physician resources.
• Complete other assigned functions as requested by management.

Skills

Organizational skills

Communication skills

MS Office

Problem solving

NJ driver’s license

Education

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

Graduate degree in Social Work or Health & Behavioral Science preferred

Tools

MS Office (Excel/Access/Word)

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to perform care coordination for specialty populations. The role ensures appropriate care levels and plans transitions across the continuum of care, guided by plan-based clinical practice guidelines.

The candidate will partner with members, families, physicians, and the healthcare team to meet needs, monitor utilization, and document activities accurately.