Care Manager I – Specialty Programs, Childhood Lead Program

Job not on LinkedIn

🕒 2 days ago

🦌 Connecticut, New Jersey, +2 more states – Remote

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

💵 $70.5k - $94.4k / year

⏰ Full Time

🟠 Senior

👔 Manager

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Assess members’ clinical needs against established guidelines and standards for specialty populations. • Implement high-quality, cost-effective care using customized population models and clinical practice guidelines. • Partner with members and families, physicians, and healthcare team members to meet member needs. • Advocate for members across care sites and coordinate resource utilization. • Set priorities, plan, organize, and implement interventions directed toward self-care outcomes and transition to independent status. • Monitor utilization to ensure care for mandated non-compliant members. • Document accurately and comprehensively according to standards of practice and organizational policies. • Evaluate care by problem solving, analyzing variances, and participating in quality improvement. • Monitor care activities and outcomes for appropriateness and effectiveness across service sites and networks. • Consult internal stakeholders on complex cases and escalate cases to internal physician resources when appropriate. • 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. • Minimum of three (3) years’ experience serving members with special needs. • Strong knowledge of standards of practice for case managers. • Strong knowledge of managed care principles. • Strong knowledge of specialty populations, as applicable. • Strong organizational skills. • Strong oral and written communication skills. • Good PC skills and ability to use Microsoft Office applications, including Excel, Access, and Word. • Good problem-solving and conflict-resolution skills. • Requires a car with valid New Jersey State License and insurance for certain positions. • Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏖️ Benefits

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