RN Data Analyst: Stop-Loss Risk & Care Management

Horizon Blue Cross Blue Shield NJ; New Jersey; 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, based in Newark, NJ, is seeking a role focused on stop loss risk management activities and coordinating risk oversight with care delivery teams. The ideal candidate will excel at managing high-risk patient care and have a solid understanding of healthcare delivery systems.

This full-time position offers the chance to work with care management to identify high-risk patients, assess clinical needs against guidelines, and engage claimants in care

Qualifications

• Minimum high school diploma or GED.
• Prefer an Associate's or Bachelor's degree in nursing or a health-related field.
• Active NJ Registered Nurse License required.

Responsibilities

• Identify potential high-risk patients with care management.
• Assess patients' clinical needs against guidelines.
• Engage high-risk claimants in care management protocols.
• Coordinate with sales and account management for engagement.
• Coordinate supporters for high-risk patients.
• Use reporting tools to assess risk on medical and pharmacy claims.
• Ensure care management protocols for members outside service areas.
• Help evaluate risks in existing and potential stop loss groups.
• Collaborate with pharmacy management on specialty drug usage.
• Analyze variances and participate in quality improvement programs.

Skills

Clinical experience

Healthcare payer experience

Nursing background

Risk management

Education

Associate's or Bachelor's degree in nursing or health-related field

Job description

Horizon Blue Cross Blue Shield of New Jersey, based in Newark, NJ, is seeking a role focused on stop loss risk management activities and coordinating risk oversight with care delivery teams. The ideal candidate will excel at managing high-risk patient care and have a solid understanding of healthcare delivery systems.

This full-time position offers the chance to work with care management to identify high-risk patients, assess clinical needs against guidelines, and engage claimants in care