Specialty Care Manager I: Coordinated Care & Outcomes

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); Sur place; USD 71 000 - 94 000; Plein temps

Avantages offerts par ce poste

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Résumé du poste

Horizon BCBSNJ seeks a Care Manager I - Specialty Programs to coordinate care for specialty populations using established guidelines and to plan seamless transitions along the continuum of care. The role emphasizes efficient utilization of benefits and high-quality, cost-effective care.

You will collaborate with members, families, physicians, and the healthcare team; document comprehensively; monitor utilization; and contribute to quality improvement while advocating for members across sites.

Qualifications

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

Responsabilités

• Assess member's clinical need against guidelines for specialty population-based members.
• Implement high quality, cost-effective care based on a population model and guidelines.
• Partner with member/family, physician, and healthcare team to meet needs and coordinate resource utilization.
• Use the care management process to set priorities, plan, organize, and implement interventions.
• Monitor utilization to ensure care for non-compliant members.
• Document accurately based on standards of practice and policies.
• Evaluate care through problem solving and quality improvement activities.

Connaissances

Organizational skills

Oral and written communication

MS Office proficiency

Problem solving

Conflict resolution

Driving

Formation

RN license

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

Graduate level degree preferred

Description du poste

Horizon BCBSNJ seeks a Care Manager I - Specialty Programs to coordinate care for specialty populations using established guidelines and to plan seamless transitions along the continuum of care. The role emphasizes efficient utilization of benefits and high-quality, cost-effective care.

You will collaborate with members, families, physicians, and the healthcare team; document comprehensively; monitor utilization; and contribute to quality improvement while advocating for members across sites.