Field-Based Care Case Manager — Impactful Patient Advocacy

Horizon Blue Cross Blue Shield of New Jersey; The Ironbound (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon BCBSNJ seeks a field-based case manager to assess and manage members' health care services, ensuring access to high-quality and cost-effective care across the care continuum.

You will collaborate with families, physicians, and care teams, documenting thoroughly and participating in quality improvement. Local travel and on-call duties may apply, with a focus on managed care principles and patient advocacy.

Qualifications

• This role requires a bachelor’s degree in a health-related or behavioral science field.
• Minimum three to four years of broad clinical experience.
• Minimum three years in home care, discharge planning, or case management; elderly frail population preferred.
• Minimum two years in the managed care industry; MLTSS may require two years in managed care.

Responsibilities

• Assist with implementation and facilitation of services to members in the program.
• Collaborate with member/family, physician, and healthcare team to coordinate care.
• Coordinate delivery of high-quality, cost-effective care based on program model and guidelines.
• Advocate for member/family among sites to coordinate resource utilization and evaluation of services.
• Interacts with member/family and healthcare team; apply care management process to set priorities and interventions.
• Encourage member participation and compliance in the case management program.
• Document accurately per standards and policies; communicate during face-to-face or telephonic contact.
• Understand fiscal accountability and its impact on resource utilization and self-care outcomes.
• Evaluate care by problem solving, variance analyses, and quality improvement participation.
• Provide field-based and/or telephonic case management activities for the program.

Skills

Organizational skills

Oral and written communication

Microsoft Office

Problem solving

Presentation skills

Independent work

Education

Bachelor degree in health/behavioral science

Active Unrestricted NJ SW License Preferred

Tools

Microsoft Office

Job description

Horizon BCBSNJ seeks a field-based case manager to assess and manage members' health care services, ensuring access to high-quality and cost-effective care across the care continuum.

You will collaborate with families, physicians, and care teams, documenting thoroughly and participating in quality improvement. Local travel and on-call duties may apply, with a focus on managed care principles and patient advocacy.