SNP Care Manager

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. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place 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 thrive. When our employees bring their best and succeed, the Company succeeds.

About The Role

This position is accountable for the assessment and case management of Dual Special Needs members using established guidelines to ensure appropriate level of care as well as developing a member centric plan of care.

Responsibilities

• Assess members' clinical, functional, and psychosocial needs using established clinical guidelines and care management standards.
• Evaluate the medical necessity, appropriateness, and effectiveness of services provided.
• Develop, coordinate, and support implementation of individualized, member-centered care plans.
• Identify healthcare needs, barriers to care, and opportunities to improve outcomes.
• Coordinate care and services with members, families, physicians, hospitals, community organizations, and other healthcare providers.
• Ensure seamless care coordination across the continuum of care, from diagnosis through treatment and ongoing support.
• Advocate for members and families to ensure access to appropriate services, programs, and community resources.
• Facilitate resource utilization and service coordination across multiple care settings.
• Provide field-based and telephonic case management services for -SNP members.
• Monitor healthcare services and member outcomes regardless of the site of care.
• Track member progress and evaluate the effectiveness of interventions and care plans.
• Identify changes in member conditions and coordinate timely interventions as needed.
• Maintain accurate, thorough, and timely documentation in accordance with professional standards and organizational policies.
• Ensure adherence to care management guidelines, regulatory requirements, and quality standards.
• Support delivery of high-quality, cost-effective care guided by evidence-based clinical practice standards.
• Promote quality outcomes through ongoing assessment, monitoring, and follow-up.

Requirements

Education & Experience:

• High School Diploma or GED required.
• Minimum of