Remote Care Manager I - Specialty Programs

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive 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 Care Manager I - Specialty Programs to coordinate care for specialty populations across Hunterdon & Somerset Counties. This full-time role offers remote work options with occasional on-site collaboration in Hopewell, NJ, and a focus on ensuring appropriate, high-quality, cost-effective care.

The ideal candidate will hold an RN license or a bachelor's degree in social work, health, or behavioral science, with at least three years'

Qualifications

• RN license or bachelor's degree in social work, health or behavioral science required.
• Minimum 3 years of experience serving members with special needs.
• Strong knowledge of case management standards and managed care principles.

Responsibilities

• Assess member's clinical need against guidelines for specialty populations.
• Coordinate care with member, family, physician, and healthcare team to meet needs.
• Monitor utilization and ensure appropriate level of care.
• Document according to standards of practice and policies.
• Collaborate with internal stakeholders on complex cases and escalate as needed.

Skills

Organizational skills

Communication skills

Problem solving

Conflict resolution

PC skills

Education

RN license

Bachelor's degree in social work/health/behavioral science

Graduate degree preferred

Tools

Microsoft Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations across Hunterdon & Somerset Counties. This full-time role offers remote work options with occasional on-site collaboration in Hopewell, NJ, and a focus on ensuring appropriate, high-quality, cost-effective care.

The ideal candidate will hold an RN license or a bachelor's degree in social work, health, or behavioral science, with at least three years'