RN Care Manager, Specialty Programs

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; 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 Blue Cross Blue Shield of New Jersey is seeking a Care Manager I – Specialty Programs to coordinate care for specialty populations under established guidelines and ensure appropriate levels of care across transitions.

The role requires an RN license or a bachelor’s in social work/health/behavioral science, with a graduate degree preferred and at least three years of experience with members who have special needs.

Qualifications

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

Responsibilities

• Assess member’s clinical need against established guidelines and/or standards for specialty population-based members.
• Implement the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan.
• Partner with the member/family, physician, and all members of the healthcare team to ensure the member’s needs are met, internal and external to this organization.
• Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status.
• Ensure care for mandated non-compliant members through the monitoring of utilization.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes.
• Monitor member’s care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness.
• Consult with internal stakeholders on complex cases and elevate as appropriate to internal physician resources.
• Complete other assigned functions as requested by management.

Skills

Organizational skills

Oral and written communication

Microsoft Office proficiency

Problem solving

Conflict resolution

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 coordinate care for specialty populations under established guidelines and ensure appropriate levels of care across transitions.

The role requires an RN license or a bachelor’s in social work/health/behavioral science, with a graduate degree preferred and at least three years of experience with members who have special needs.