DSNP Care Manager (Passaic County)

100 Horizon Healthcare Services, Inc; Newark (NJ); On-site; USD 63,000 - 84,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is hiring for a field-based Care Management role focused on Dual Eligible SNP members. You will assess clinical and psychosocial needs, develop tailored care plans, and coordinate services across providers to improve outcomes.

The position emphasizes advocacy, documentation, and adherence to regulatory standards. A NJ license and 3+ years’ relevant experience are required, with a strong focus on quality and patient-centered care.

Qualifications

• High School Diploma or GED required
• Minimum of three (3) years of broad clinical experience
• Minimum of three (3) years of experience in home care, discharge planning, case management, or related healthcare setting
• Active, unrestricted New Jersey license (RN/LPN/SW/CSW)

Responsibilities

• Assess members' clinical, functional, and psychosocial needs using established guidelines and care management standards.
• Develop, coordinate, and support implementation of individualized, member-centered care plans.
• Coordinate care and services with members, families, physicians, hospitals, and community organizations.
• Provide field-based and telephonic case management for SNP members.
• Maintain documentation per professional standards and organizational policies.

Skills

Clinical assessment

Care planning

Care coordination

Advocacy

Communication

Education

High School Diploma or GED

Bachelor's degree in Nursing, Social Work, Healthcare (preferred)

Tools

None

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

This field based position is accountable for the assessment and case management of Dual Special Needs members using established guidelines to ensure appropriate level of care as well as developing a member centric plan of care.

What You'll Do

Member Assessment & Care Planning

Assess members' clinical, functional, and psychosocial needs using established clinical guidelines and care management standards. Evaluate the medical necessity, appropriateness, and effectiveness of services provided. Develop, coordinate, and support implementation of individualized, member-centered care plans. Identify healthcare needs, barriers to care, and opportunities to improve outcomes.

Care Coordination & Member Advocacy

Coordinate care and services with members, families, physicians, hospitals, community organizations, and other healthcare providers. Ensure seamless care coordination across the continuum of care, from diagnosis through treatment and ongoing support. Advocate for members and families to ensure access to appropriate services, programs, and community resources. Facilitate resource utilization and service coordination across multiple care settings.

Case Management & Monitoring

Provide field-based and telephonic case management services for -SNP members. Monitor healthcare services and member outcomes regardless of the site of care. Track member progress and evaluate the effectiveness of interventions and care plans. Identify changes in member conditions and coordinate timely interventions as needed.

Quality, Documentation & Compliance

Maintain accurate, thorough, and timely documentation in accordance with professional standards and organizational policies. Ensure adherence to care management guidelines, regulatory requirements, and quality standards. Support delivery of high-quality, cost-effective care guided by evidence-based clinical practice standards. Promote quality outcomes through ongoing assessment, monitoring, and follow-up.

Required Qualifications & Knowledge

Education & Experience

High School Diploma or GED required. Minimum of three (3) years of broad clinical experience. Minimum of three (3) years of experience in home care, discharge planning, case management, or a related healthcare setting. Minimum of three (3) years of experience working within the healthcare delivery system. Active, unrestricted New Jersey license as one of the following: Registered Nurse (RN) Licensed Practical Nurse (LPN) Social Worker (SW) Certified Social Worker (CSW)

Required Knowledge

Strong knowledge of case management standards and best practices. Strong understanding of managed care concepts and healthcare delivery systems. Knowledge of HEDIS measures and quality improvement principles. Strong knowledge of medical terminology. Understanding of care coordination, resource management, and member advocacy. Knowledge of community resources and support services available to vulnerable populations.

Preferred Qualifications & Knowledge

Education & Experience

Bachelor's degree in Nursing, Social Work, Healthcare, Behavioral Health, or a related field. Experience working with elderly, frail, disabled, or complex-needs populations. Experience supporting Medicare, Medicaid, Dual Eligible, or Special Needs Plan (SNP) populations. Experience conducting field-based care management and home visits.

Preferred Knowledge

Familiarity with dual eligibility programs and government-sponsored healthcare plans. Knowledge of population health management and chronic condition management. Understanding of social determinants of health and their impact on healthcare outcomes. Experience coordinating care across medical, behavioral health, and community-based services.

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.

Salary Range:

$63,000 - $84,420. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.

Horizon also provides a comprehensive compensation and benefits package which includes:

• 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.