Self-Direction PPP Support Counselor (Field Based - Bergen 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

The Self-Direction PPP Support Coordinator is responsible for conducting quarterly in-person evaluations on members enrolled in the Personal Preference Program. During these quarterly meetings, the Support Coordinator handles all workforce functions including budgeting, back-up planning, capacity planning, forecasting, safety planning, scheduling, and real-time monitoring. The role provides member assistance and strategic insight during the development and review of the member’s cash management plan, budget performance, review of monthly results, and ensures the cash management plan meets the member’s needs.

Responsibilities

• Work with members to develop a cash management plan that is member-specific, member-choice, and member-centric, enabling the member to use their budget to meet their daily needs.
• Review monthly cash expenditures to ensure the member stays within their monthly budget allowance.
• Review and update the monthly budget on a quarterly basis, as needed.
• Develop and review the member’s back-up plan on a quarterly basis.
• Review worker timecards to analyze PTO submissions, EVV compliance, and hours of work.
• Update and maintain the member’s electronic medical record.
• Identify, report, and follow up on allegations or reports of suspected fraud, waste, neglect, or abuse.
• Identify and maintain available community resources and other services.
• Maintain timely documentation: in-home visit notes must be completed during the visit and uploaded on the same day.
• Educate members on notification requirements for changes in condition, hospitalizations, or caregiver issues.
• Provide education on safety tips, including but not limited to fall risk prevention.
• Ensure clear and consistent communication.
• Perform other relevant tasks as assigned by management.

Requirements

• High School Diploma/GED required.
• LPN or healthcare background preferred.
• Equivalent and relevant professional experience in budgeting or finance preferred but not required.
• Minimum of 3 years’ experience in the health insurance industry or a professional business-related field.
• Experience with MS Office and other workforce management (WFM) solutions highly preferred.

Skills and Abilities

• Strong analytical skills with an emphasis on forecasting.
• Ability and willingness to learn new software applications.
• Skills in problem-solving, judgment, critical thinking, and decision-making.
• Highly organized with an emphasis on accuracy and timeliness.
• Ability to organize information, follow procedures accurately, and pay attention to detail.
• Ability to work independently with minimal supervision and collaboratively in a team environment, occasionally under time pressure and on multiple tasks.
• Ability to visit a diverse population of participants in their homes, which may encompass a wide range of home settings.
• Ability to assume an increased home visit schedule (i.e., greater than 60% of working hours) as dictated by business needs.
• Ability to organize home visit caseload to ensure efficient use of driving time.

Benefits

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

Pay

Salary Range: $63,000 - $84,420. This range is specific to the job level and considers factors such as education, experience, licensure, certifications, geographic location, and internal equity.

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