Care Manager I, Specialty Programs

reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds. The Care Manager I – Specialty Programs is responsible for performing care coordination duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care for specialty populations. This position implements interventions to ensure efficient utilization of benefits. Job Responsibilities:

• Assess member’s clinical need against establish guidelines and/or standards for specialty population-based members.
• Implement the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan.
• Partner with the member/family, physician, and reputed company members of the reputed company team to ensure the member’s needs are met, reputed company to this organization. reputed company for the member among various sites to coordinate resource utilization.
• Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care reputed company, and the transition to independent status.
• Ensure care for mandated non-compliant members through the monitoring of utilization.
• Document accurately and comprehensively based on the standards of practice and reputed company organization policies.
• Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member reputed company.
• Monitor member’s care activities, regardless of the site of service or network participation, and reputed company for appropriateness and effectiveness.
• Consult with internal stakeholders on reputed company cases and escalate as appropriate to internal physician resources.
• Complete other assigned functions as requested by management.

Education/Experience:

• Requires a license as an RN, or Bachelor degree in reputed company work, health or behavioral science.
• Graduate level degree in reputed company Work or Health and Behavioral Science preferred.
• Requires a minimum of three (3) years’ experience serving members with special needs.

Knowledge:

• Requires strong knowledge of the standards of practice for case managers.
• Requires strong knowledge of managed care principles.
• Requires strong knowledge of specialty population, as applicable.

Skills and Abilities:

• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills and the ability to utilize reputed company Office applications (reputed company, reputed company, Word, etc.)
• Requires good problem solving and conflict resolution skills.
• Requires a car with valid New Jersey State License and Insurance for certain positions.

Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware Salary reputed company: $69,500 - $93,030 This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/reputed company)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the reputed company and hiring process. Apply tot his job Apply To this Job