Remote DSNP Care Manager – Dual Special Needs Focus

Horizon Blue Cross Blue Shield; New Jersey, United States, Northern America, Americas; Hybrid; 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 DSNP Care Manager to assess and manage Dual Special Needs members across Somerset County and beyond, using established guidelines to ensure appropriate care.

In this field-based and telephonic role, you will develop individual plans of care, coordinate with families and providers, and monitor outcomes while advocating for members and documenting care according to policy.

Qualifications

• High School Diploma or GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Active NJ SW/RN/LPN license or CSW required.
• Minimum of three years clinical experience in health care settings.
• Experience in home care, discharge planning, or case management preferred.

Responsibilities

• Assess patient clinical needs against guidelines to ensure services are medically appropriate.
• Evaluate the necessity and efficiency of provided services.
• Develop, coordinate, and implement the member’s plan of care.
• Coordinate with patient, family, physician, hospital and other external stakeholders.
• Deliver high quality, cost‑effective care across the continuum of care.
• Monitor care activities and outcomes for appropriateness and effectiveness.
• Advocate for the member and family across sites for resource utilization.
• Document thoroughly per practice standards and policies.
• Provide field-based and/or telephonic case management for the Dual Special Needs program.

Skills

Organizational skills

Communication skills

Problem solving

Presentation skills

Team collaboration

Education

High School Diploma/GED

Bachelor degree preferred

Active NJ SW/RN/LPN License or CSW

Tools

Microsoft Office

Microsoft Excel

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a DSNP Care Manager to assess and manage Dual Special Needs members across Somerset County and beyond, using established guidelines to ensure appropriate care.

In this field-based and telephonic role, you will develop individual plans of care, coordinate with families and providers, and monitor outcomes while advocating for members and documenting care according to policy.