Case & Care Coordination Specialist (Managed Care)

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 50,000 - 67,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking to strengthen Clinical Operations by providing leadership to a non-clinical team and coordinating between members, physicians, delegates, and case managers. The role emphasizes servicing members, coordinating care, and resolving escalated issues with a focus on benefits and treatment coordination.

The position includes on-boarding; training of new Managed Care Coordinators I; and acting as a liaison with providers, members, and Care

Qualifications

• High School Diploma/GED required.
• 3-5 years customer service experience.
• Strong communication and teamwork.

Responsibilities

• Review service requests for completeness and transfer of non-clinical data.
• Prepare and route cases in clinical review systems.
• Initiate callbacks to members/providers to verify benefits and treatment.
• Collate information to handle escalated inquiries.
• Coordinate onboarding and training for new Coordinators I.

Skills

Leadership

Customer service

Communication

Team collaboration

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking to strengthen Clinical Operations by providing leadership to a non-clinical team and coordinating between members, physicians, delegates, and case managers. The role emphasizes servicing members, coordinating care, and resolving escalated issues with a focus on benefits and treatment coordination.

The position includes on-boarding; training of new Managed Care Coordinators I; and acting as a liaison with providers, members, and Care