Care Manager I, Specialty Programs – Childhood Lead Program
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Care Manager I coordinating care for specialized populations at Horizon Blue Cross Blue Shield. Implementing high-quality, cost-effective care for diverse member health needs.
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 all members of the healthcare team to ensure the member’s needs are met, internal and external to this organization.
- Advocate 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 outcomes, 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 current organization policies.
- Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes.
- Monitor member’s care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness.
- Consult with internal stakeholders on complex cases and escalate as appropriate to internal physician resources.
- Complete other assigned functions as requested by management.
Requirements:
- 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.
- 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.
- Requires strong organizational skills.
- Requires strong oral and written communication skills.
- Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
- Requires good problem solving and conflict resolution skills.
- Requires a car with valid New Jersey State License and Insurance for certain positions.
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Similar Jobs
Corporate Development Manager
Corporate Development Manager at MeridianLink overseeing M&A activities for the fintech sector. Collaborating with various stakeholders to build and refine M&A strategies.
Retail Assistant Store Manager
Assistant Store Manager at Skechers driving daily performance and team success through operations management. Mentoring employees, managing inventory, and ensuring excellent customer service.
Field Service Manager
Field Service Manager leading technical services across British Columbia in electrical services industry. Responsible for operational performance, team leadership, and customer satisfaction.
Senior M&A Integration Manager
Senior M&A Integration Manager facilitating acquisitions for ReSource Pro. Managing integration plans and collaborating with stakeholders for successful execution.
Senior Manager, Resilience Technology
Senior Manager in Resilience Technology at Labcorp responsible for FusionRM platform delivery and governance. Collaborating with cross-functional teams to enhance enterprise risk, compliance, and resilience strategies.
Senior Manager, Client Management – Alight Leave Solutions
Senior Manager responsible for managing complex client relationships at Alight. Driving strategies for client success and retention in benefits solutions sector.
Injury Manager
Injury Manager leading a remote team handling liability and bodily injury claims. Driving adherence to processes and improving claims handling while maintaining high satisfaction levels.
Value Manager
Value Manager driving strategic discovery and engagement with executive stakeholders across industries. Collaborating to articulate the value of Workday’s platform while delivering compelling business cases and presentations.
Study Manager
Study Manager supporting operational conduct of clinical studies in ophthalmology. Collaborating with teams and managing timelines for clinical drug development.
National Training, Quality Manager
National Training & Quality Manager responsible for strategic leadership and execution of Training and Quality programs at NQX. Leading a team to ensure excellence in customer experience for Canada Post.
Grants Manager
Grants Manager for GI-TOC managing diverse grant portfolios and ensuring compliance. Supporting programme teams through the full grant cycle with a focus on effective management and donor relations.
Portfolio Manager
Portfolio Manager at Cengage developing product strategies for the education market. Leading product development and ensuring quality learning experiences for students and instructors.
Site Quality Manager
Site Quality Manager responsible for planning, organizing, and leading quality work in the field for Hitachi Energy. Ensuring customer satisfaction while collaborating with stakeholders and adhering to quality standards.
Indirect Distributor Business Manager
Distributor Business Manager accountable for distributor performance in Indiana, Michigan and Ohio, leveraging Salesforce CRM and supporting sales strategy for customer acquisition.
Senior Revenue Intelligence Manager
Data-driven strategist overseeing Reporting & Insights in Revenue Operations at Introhive. Responsible for translating revenue strategy into actionable data and improving decision-making processes.
Senior Manager, International Learning, Oncology
Senior Manager supporting oncology learning strategies at AbbVie. Developing integrated learning plans and collaborating with brand teams to enhance education effectiveness.
District Manager, Neuroscience
District Manager overseeing in-field commercial activity in Neuroscience at AbbVie. Coordinating teams to achieve sales targets in Manhattan, NY.
Market Access Manager – Sr. Market Access Manager
Market Access Manager ensuring successful market access strategies for Sobi’s pipeline in Germany. Focus on integrated access planning, policy shaping, and sustainable patient access.
Behavioral Health Care Manager
Behavioral Health Care Manager coordinating patient care in a virtual setting for April Health. Focus on Collaborative Care model and evidence-based mental health treatments.
Senior District Manager
District Manager for immunology at AbbVie managing sales and client relationships in the Chengdu region. Leading team training and ensuring compliance with market strategies.