Specialty Care Manager I — Care Coordination Pro

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 in alignment with clinical guidelines and plan models.

You will collaborate with members, families and the healthcare team to ensure appropriate care and efficient utilization of benefits, while documenting and evaluating outcomes to drive quality improvements.

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 established guidelines for specialty population-based members.
• Implement delivery of high quality, cost-effective care based on model of care.
• Partner with member/family, physician, and healthcare team to coordinate resource utilization.
• Utilize the care management process to plan, organize, and implement interventions.
• Monitor utilization for mandated non-compliant members.
• Document accurately per practice standards and policies.
• Evaluate care durch problem solving and quality improvement participation.
• Monitor care activities and outcomes across sites and networks.
• Consult with internal stakeholders on complex cases and escalate as needed.
• Complete other functions as requested by management.

Skills

Organizational skills

Oral and written communication

Problem solving

Conflict resolution

Education

RN license

Bachelor degree in social work/health/behavioral science

Graduate degree preferred

Tools

Microsoft Office (Excel/Access/Word)

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Care Manager I - Specialty Programs to coordinate care for specialty populations in alignment with clinical guidelines and plan models.

You will collaborate with members, families and the healthcare team to ensure appropriate care and efficient utilization of benefits, while documenting and evaluating outcomes to drive quality improvements.