Specialty Care Manager I

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Dental/Vision

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 and plan transitions along the continuum of care. You will implement interventions based on guidelines to ensure efficient utilization of benefits and high-quality member care.

You will partner with members, families, physicians and the healthcare team to meet needs, document care, and support successful outcomes.

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 establish guidelines for specialty populations.
• Implement delivery of high quality, cost-effective care with a population model.
• Partner with member/family, physician, and healthcare team to meet needs and advocate across sites.
• Utilize care management process to set priorities and plan interventions for self-care and transition.
• Ensure care for non-compliant members through monitoring of utilization.
• Document accurately based on practice standards and policies.
• Evaluate care by problem solving, analyzing variances, and participating in quality improvement.
• Monitor member care activities and outcomes for appropriateness and effectiveness.
• Consult with internal stakeholders on complex cases and elevate to physician resources.
• Complete other assigned functions as requested by management.

Skills

Organizational skills

Oral and written communication

MS Office

Problem solving

NJ driver's license

Education

RN license

Bachelor's degree in social work/health/behavioral science

Graduate degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations and plan transitions along the continuum of care. You will implement interventions based on guidelines to ensure efficient utilization of benefits and high-quality member care.

You will partner with members, families, physicians and the healthcare team to meet needs, document care, and support successful outcomes.