RN, Data Analyst

Vaga não está no LinkedIn

🔥 13 horas atrás

🦌 Connecticut, New Jersey, +2 estados a mais – Remoto

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $79.100 - $105.945 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

📉 Analista de Dados

👻 Score fantasma 14%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Horizon Connect @ Wall BCBSNJ

SiteLinkedInTodas as Vagas

2 - 10 funcionários

⚕️ Seguro de Saúde

🏥 Saúde

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ é uma presença no LinkedIn ou programa/escritório local associado ao Horizon Blue Cross Blue Shield de New Jersey (BCBSNJ). Com base no nome e no contexto, parece estar conectado às operações de seguro de saúde do Horizon BCBSNJ e ao alcance local ou envolvimento de membros/provedores na área de Wall, NJ. As informações disponíveis publicamente são limitadas e consistem principalmente na interface do site do LinkedIn em vez de um perfil da empresa, então essa descrição é conservadora e baseada na afiliação indicada pelo nome.

Descrição

• Focus stop loss risk management activities on the centralized stop loss team and coordinate risk oversight with care delivery areas • Assure care is coordinated across the company and throughout the care delivery system for high risk members • Use established guidelines to ensure appropriate levels of care and plan transitions of care • Work with care management and delivery functions to identify potential high risk patients in new business and renewal groups • Assess patients' clinical needs against established guidelines • Ensure high risk claimants are engaged in care management protocols • Elicit support from sales, account management, brokers, consultants and group customers • Coordinate support for high risk patients with families, employers and other appropriate parties • Use reporting and risk identification tools on medical and pharmacy claims to assess risk • Maintain care management protocols for members receiving care outside the service area • Assist in evaluating risks in existing and potential stop loss groups • Coordinate with pharmacy management regarding specialty drug usage and site of service delivery • Evaluate care, analyze variances and participate in quality improvement programs • Respond to preferred partner inquiries regarding large claimants • Act as a resource to sales and account management teams regarding case management services and stop loss management • Identify and manage high risk claimants within established and prospective stop loss customers • Ensure appropriate care levels and engagement across company functions and care delivery systems • Perform other duties assigned by management

🎯 Requisitos

• Minimum high school diploma or GED • Prefer an Associate's or Bachelor's degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school • Requires a minimum of two (2) years of clinical experience • Requires minimum of three (3) years of experience in the health care delivery system/industry • Requires minimum of two (2) years of experience with health care payer experience • Requires an active NJ Registered Nurse License • Prefers pending or obtained certification in case management or other applicable clinical specialties • Prefer advanced Excel, SQL or Tableau • Experience creating dashboards and reports • Requires understanding of health and prescription insurance products, contracts and benefits eligibility • Requires understanding of health delivery systems and professionals • Requires understanding of case/care/disease management principles • Requires strong inter-personal skills with a demonstrated ability to work across divisions and with external stakeholders • Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) and Lotus Notes

🏖️ Benefícios

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