RN Data Analyst for Stop-Loss & Care Coordination

100 Horizon Healthcare Services, Inc; Newark (NJ); On-site; USD 79,000 - 106,000; 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 experienced professional to manage stop loss risk activities and coordinate oversight across the care delivery system. The role requires engagement with care management and sales teams to ensure medically necessary care levels for high risk members.

Responsibilities include using claims data to identify risk, coordinating with brokers and groups, and supporting provider resources to deliver value in care transitions.

Qualifications

• Two years of clinical experience required.
• Three years of experience in the health care delivery system/industry.
• Two years of health care payer experience.
• Advanced Excel, SQL or Tableau preferred.
• Experience creating dashboards and reports.

Responsibilities

• Identify potential high risk patients in new business and renewal groups and assess clinical need.
• Engage high risk claimants in care management protocols.
• Coordinate with sales, account management, brokers, consultants and group customers to ensure engagement.
• Support care management resources for high risk patients and families.
• Use reporting tools on medical and pharmacy claims to assess risk.
• Ensure care management protocols for members outside service area are maintained.

Skills

Excel

SQL

Tableau

Education

High school diploma

Associate or Bachelor in nursing/health field

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a experienced professional to manage stop loss risk activities and coordinate oversight across the care delivery system. The role requires engagement with care management and sales teams to ensure medically necessary care levels for high risk members.

Responsibilities include using claims data to identify risk, coordinating with brokers and groups, and supporting provider resources to deliver value in care transitions.