Dual-Eligible SNP Care Manager

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 nurse or social work professional for Dual SNP case management. The role emphasizes assessing clinical, functional, and social needs and building member-centered care plans.

You will coordinate services across providers and advocate for access to appropriate programs, with a focus on quality outcomes and cost-effective care. Qualified candidates hold an active NJ license (RN, LPN, SW, or CSW) and have several years of experience

Qualifications

• Must have strong knowledge of case management standards.
• Strong understanding of managed care concepts and healthcare delivery systems.
• Knowledge of HEDIS measures and quality improvement principles.
• Strong knowledge of medical terminology.

Responsibilities

• Assess members' clinical, functional, and psychosocial needs using guidelines.
• Evaluate medical necessity, appropriateness, and effectiveness of services.
• Develop, coordinate, and support member-centered care plans.
• Advocate for members to access needed services and community resources.

Skills

Case management

Care coordination

Education

High School Diploma or GED required

Bachelor's degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a dedicated nurse or social work professional for Dual SNP case management. The role emphasizes assessing clinical, functional, and social needs and building member-centered care plans.

You will coordinate services across providers and advocate for access to appropriate programs, with a focus on quality outcomes and cost-effective care. Qualified candidates hold an active NJ license (RN, LPN, SW, or CSW) and have several years of experience