Care Manager I, Specialty Programs
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Care Manager I at Horizon Blue Cross Blue Shield coordinating care for specialty populations and implementing high-quality, cost-effective care. Manage member advocacy and resource utilization while ensuring compliance with care standards.
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's 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
Senior Enablement Manager
Senior Enablement Manager at Jabil providing leadership and strategy for PMO activities. Ensuring project management teams effectively execute initiatives and improve operational readiness.
RN II, Primary Nurse Care – Case Manager
RN Care Manager tasked with clinical responsibilities for high risk members. Engaging in preventative care and developing individualized care plans for optimal member outcomes.
RN II, Case Manager
RN II Case Manager for Horizon Blue Cross Blue Shield overseeing patient care using established guidelines. Responsible for planning, assessment, and coordination of care for members' health services.
APAC BD and Channel Manager
Business Development Manager for LGC AXIO Proficiency Testing focusing on the South Korea and Japan markets. Developing relationships, acquiring partners, and driving sales strategies to meet revenue goals.
Asset Manager, Foreclosure
Asset Manager supporting foreclosure processing and auctions at Altisource. Listing, tracking, and managing foreclosure properties for timely sales and compliance.
Area Manager
Area Manager at GoFi responsible for driving loan volume and building dealer relationships. Focused on consultative selling, training, and strategic influence to maximize market presence.
Manager, RCM Services
Manager overseeing RCM services for a behavioral health organization. Leading and mentoring a billing team to ensure operational goals and client satisfaction.
Customer Assistance Manager
Customer Assistance Manager managing efficient operations and logistics for the leasing business. Ensuring exceptional customer service and driving performance in the Dallas area with high travel requirements.
Manager, Advanced Analytics
Manager in Advanced Analytics overseeing data projects and team analytics in a remote setup. Engaging in health measurement expertise and implementing business intelligence solutions.
Business Area Manager – Nursing
Business Area Manager overseeing remote Field Nurses to drive operational excellence at Cencora. Focused on Key Performance Indicators and maintaining high standards of nursing operations.
Field Nurse Case Manager
Field Nurse Case Manager managing patient enrollment and reimbursement processes for Cencora's healthcare programs. Collaborating with physicians while supporting patients throughout their care and therapy processes.
Critical Care Business Manager – INOmax
Business Manager leading commercial efforts for inhaled nitric oxide therapy in Eastern Canada. Collaborating with medical and commercial teams to grow medical device usage in targeted hospitals.
Field Reimbursement Manager
Field Reimbursement Manager providing access and reimbursement support for Keenova products. Collaborating with healthcare providers and internal teams to facilitate patient access.
Engagement Team Manager
Engagement Team Manager overseeing member outreach at RightMove Health. Leading a team and enhancing engagement strategies while providing direct support to members via the phone.
Assistant Manager, Curriculum and Instruction
Assistant Manager responsible for leading educational programs at Texas Virtual Academy. Ensuring compliance with educational standards and managing staff in a remote environment.
Manager, Public Sector
Manager Acquisition Hunting leading sales in the public sector at HPE. Responsible for customer engagement, team performance, and strategic sales management.
Regional Retail Manager
Retail Regional Manager responsible for overseeing and developing retail sales organization at Acosta. Ensuring adherence to company policies and enhancing sales coverage in assigned territory.
Practice Transformation Manager
Practice Transformation Manager leading implementation of value-based care programs at Vytalize Health. Collaborating with providers to optimize health management strategies and improve patient outcomes.
IT Lizenzmanager
IT Lizenzmanager at OneQrew ensuring compliant software license management and strategic alignment with IT and business. Focus on risk minimization and audit readiness while managing software licenses.
Patient Access Appeals Case Manager – VA
Patient Access Case Manager supporting patient reimbursement journeys for Noctrix Health's innovative therapy. Liaising between patients, providers, and insurance companies to ensure access.