Senior SNP Care Manager: Compassionate Care & Coordination

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; 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 Dual Special Needs case manager to assess and plan care for SNP members, coordinating with families, physicians, and care teams. The role focuses on ensuring appropriate care and improving outcomes, with field-based and telephonic management as needed.

Qualified candidates hold an active NJ license (RN/LPN/SW/CSW) and have 3+ years in home care or related settings.

Qualifications

• High School Diploma or GED required.
• Minimum of three (3) years of broad clinical experience.
• Minimum of three (3) years of experience in home care, discharge planning, case management, or a related healthcare setting.
• Minimum of three (3) years of experience working within the healthcare delivery system.
• Active, unrestricted New Jersey license as RN/LPN/SW/CSW.

Responsibilities

• Assess members' clinical, functional, and psychosocial needs using established guidelines.
• Evaluate medical necessity, appropriateness, and effectiveness of services.
• Develop, coordinate, and support member-centered care plans.
• Coordinate care with members, families, physicians, hospitals, and community resources.
• Advocate for members to access services and resources.
• Provide field-based and telephonic case management for SNP members.
• Monitor outcomes and track progress of interventions.
• Document thoroughly in line with standards and policies.
• Ensure adherence to care management guidelines, regulatory requirements, and quality standards.

Skills

Case management

Managed care

HEDIS

Medical terminology

Care coordination

Community resources

Population health

Education

Active NJ license (RN/LPN/SW/CSW)

Bachelor's degree preferred

High School Diploma or GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Dual Special Needs case manager to assess and plan care for SNP members, coordinating with families, physicians, and care teams. The role focuses on ensuring appropriate care and improving outcomes, with field-based and telephonic management as needed.

Qualified candidates hold an active NJ license (RN/LPN/SW/CSW) and have 3+ years in home care or related settings.