Care Specialist III (Field Based - Essex County)

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve 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.

About the role

This field-based position is accountable for the assessment and case management of members to ensure facilitation of health care services.

• Assist with implementation and facilitation of services to members in the program.
• Collaborate with member/family, physician, and all members of the healthcare team, internal and external to this organization.
• Coordinate the delivery of high-quality, cost-effective care based on the members' needs and the program model supported by clinical practice guidelines established by the plan.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Interact with the member/family, physician, and healthcare team. Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal-directed.
• Encourage member participation and compliance in the case management program efforts.
• Utilize program case management process for goal-directed member/family care.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Interact and communicate effectively with members during face-to-face and/or telephonic contact.
• Understand fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self-care outcomes.
• Evaluate care by problem-solving, analyzing variances, and participating in the quality improvement program to enhance member outcomes.
• Provide field-based and/or telephonic case management activities specific to the case management program.
• Perform duties as assigned by management.

Requirements

• Bachelor's degree is required.
• Minimum of three (3) to four (4) years of broad clinical experience.
• Minimum of three (3) years of experience in home care, discharge planning, or case management, preferably with the elderly frail population.
• Preferred minimum of two (2) years' experience in the managed care industry.
• Active unrestricted NJ RN/SW license required. Candidates with a restricted license will not be considered.
• Requires local travel and possible on-call work specific to the managed long-term support and services case management program.

Knowledge

• Strong knowledge of the standards of practice for case managers.
• Strong knowledge of managed care principles and concepts, including Health Plan Employer Data and Information Sheet (HEDIS).

Skills and Abilities

• Strong organizational skills.
• Strong oral and written communication skills.
• Good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Good problem-solving and conflict resolution skills.
• Good presentation skills.
• Ability to work with limited daily supervision.

Travel

This is a field-based position; daily local travel is required.

Pay

Salary Range: $70,500 - $94,395. This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.

Benefits

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

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.