Specialty Care Manager I — Care Coordination Leader

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

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 perform care coordination for specialty populations, applying guidelines to ensure appropriate levels of care and smooth transitions to the continuum of care.

In this role you will partner with members, families, physicians, and the healthcare team to meet needs, document thoroughly, monitor utilization, and contribute to quality improvement while maintaining licensing and education requirements.

Qualifications

• Requires RN license or bachelor’s degree in social work, health or behavioral science.
• Graduate level degree in Social Work or Health/Behavioral Science preferred.
• Minimum of three years’ experience serving members with special needs.

Responsibilities

• Assess member’s clinical need against guidelines for specialty population-based members.
• Coordinate high-quality, cost-effective care using plan guidelines.
• Collaborate with member, family, physicians, and care team to meet needs.
• Plan and implement interventions for self-care and transition to independence.
• Monitor utilization to ensure compliant care.
• Document according to practice standards and policies.
• Evaluate care and participate in quality improvement.
• Monitor care across sites and network participation.
• Consult with internal stakeholders on complex cases.
• Complete other functions as requested by management.

Skills

Organizational skills

Oral and written communication

PC skills (Microsoft Office)

Problem solving

Conflict resolution

Education

RN license or Bachelor's degree in social work, health or behavioral science

Graduate level degree in Social Work or Health and Behavioral Science preferred

Three years' experience serving members with special needs

Tools

Microsoft Office suite

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I – Specialty Programs to perform care coordination for specialty populations, applying guidelines to ensure appropriate levels of care and smooth transitions to the continuum of care.

In this role you will partner with members, families, physicians, and the healthcare team to meet needs, document thoroughly, monitor utilization, and contribute to quality improvement while maintaining licensing and education requirements.