DSNP Care Navigator — Case Management

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 63,000 - 84,000; 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 dedicated Case Manager to assess and manage Dual Special Needs members using established guidelines to ensure an appropriate level of care and a member-centric plan of care.

You will coordinate with patients, families, physicians, hospitals, and other external stakeholders to optimize care from diagnosis to outcome, document according to policy, and perform field-based or telephonic case management for the Dual Special Needs program.

Qualifications

• Minimum three years in case management and home health.
• Experience with elderly frail population.
• Knowledge of managed care concepts and HEDIS.

Responsibilities

• Assesses patient's clinical needs against guidelines to ensure medically appropriate services.
• Evaluates necessity, appropriateness and efficiency of services.
• Develops, coordinates and assists in implementation of member's plan of care.
• Coordinates with patient, family, physician, hospital and other external customers.
• Coordinates delivery of high quality, cost-effective care guided by plan guidelines.
• Monitors patient's medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for member/family among sites to coordinate resources.
• Documents accurately based on standards and policies.
• Provides field-based and/or telephonic case management for the Dual Special Needs program.

Skills

Case management

Home health experience

Discharge planning

Communication skills

Microsoft Office

Education

High School Diploma/GED

Bachelor degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a dedicated Case Manager to assess and manage Dual Special Needs members using established guidelines to ensure an appropriate level of care and a member-centric plan of care.

You will coordinate with patients, families, physicians, hospitals, and other external stakeholders to optimize care from diagnosis to outcome, document according to policy, and perform field-based or telephonic case management for the Dual Special Needs program.