Care Navigator – Managed Care Support

Horizon-Blue-Cross-Blue-Shield-of-New-Jersey; Hopewell (NJ); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Operations liaison to support members, physicians and Care teams. You will review service requests, collect data and coordinate clinical information for pre-certification and case management, ensuring timely and accurate processing.

Ideal candidates bring knowledge of medical terminology, strong communication skills, and the ability to analyze problems with minimal supervision.

Qualifications

• Knowledge of medical terminology is required; Medicaid CM is preferred.
• Strong oral and written communication skills are essential.
• Ability to analyze and resolve problems with minimal supervision.

Responsibilities

• Review service requests for completeness and route for clinical review.
• Coordinate with members, physicians, delegations and care teams to obtain necessary information.
• Initiate calls and correspondence to members and providers to coordinate benefits and case completion.
• Liaise with providers, members and care managers to support case management.
• Triage and document clinical and non-clinical information for pre-certification workflows.

Skills

Medical terminology

Oral & Written communication

Analytical skills

Customer service mindset

Team player

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Operations liaison to support members, physicians and Care teams. You will review service requests, collect data and coordinate clinical information for pre-certification and case management, ensuring timely and accurate processing.

Ideal candidates bring knowledge of medical terminology, strong communication skills, and the ability to analyze problems with minimal supervision.