Specialty Care Manager

Horizon Blue Cross Blue Shield of New Jersey; Oregon; Híbrido; USD 71.000 - 94.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Descripción de la vacante

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations. The role emphasizes evidence-based interventions, collaboration with families, physicians, and care teams to assure appropriate utilization of benefits.

Requires RN licensure or a bachelor degree in social work/health or behavioral science, with a graduate degree preferred and at least 3 years of relevant experience.

Formación

• Requires RN license 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.

Responsabilidades

• Assess member's clinical needs against guidelines for specialty populations.
• Deliver high-quality, cost-effective care based on a population model and guidelines.
• Collaborate with member/family, physician, and healthcare team to meet needs and coordinate resources.
• Use care management process to set priorities and plan interventions toward self-care outcomes.
• Monitor care for mandated non-compliant members and utilization.
• Document accurately according to practice standards and policies.
• Evaluate care via problem solving and quality improvement activities.
• Monitor member care across sites and networks for effectiveness.
• Consult with internal stakeholders on complex cases and escalate to physician resources.
• Perform other duties assigned by management.

Conocimientos

Organizational skills

Oral and written communication

MS Office proficiency

Problem solving

Conflict resolution

Driver's license

Educación

Bachelor degree in social work, health or behavioral science

Graduate degree in Social Work or Health and Behavioral Science

Descripción del empleo

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations. The role emphasizes evidence-based interventions, collaboration with families, physicians, and care teams to assure appropriate utilization of benefits.

Requires RN licensure or a bachelor degree in social work/health or behavioral science, with a graduate degree preferred and at least 3 years of relevant experience.