RN Care Manager I – Specialty Programs

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

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I – Specialty Programs to perform care coordination using established guidelines and transition planning for specialty populations. The role focuses on efficient utilization of benefits and high-quality, cost-effective care.

You will work with members, families, physicians, and the healthcare team to coordinate resources and advocate for the member’s needs.

Qualifications

• Requires RN license or Bachelor's degree in social work, health or behavioral science.
• Graduate level degree in Social Work or Health and Behavioral Science preferred.
• Minimum of three (3) years’ experience serving members with special needs.

Responsibilities

• Assess member’s clinical need against guidelines for specialty populations.
• Implement delivery of high quality, cost-effective care based on model of care.
• Coordinate with member/family, physician, and healthcare team to meet member needs.
• Plan and implement interventions toward self-care and transition to independence.
• Monitor utilization and care for mandated non-compliant members.
• Document accurately according to standards and policies.
• Evaluate care and participate in quality improvement.
• Consult with internal stakeholders on complex cases.
• Complete other functions as requested by management.

Skills

Strong organizational

Oral and written communication

Microsoft Office

Problem solving

Education

RN license

Bachelor 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 perform care coordination using established guidelines and transition planning for specialty populations. The role focuses on efficient utilization of benefits and high-quality, cost-effective care.

You will work with members, families, physicians, and the healthcare team to coordinate resources and advocate for the member’s needs.