Care Manager I, Specialty Programs

Job not on LinkedIn

🔥 13 hours 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

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Perform care coordination duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care for specialty populations. • Implement interventions to ensure efficient utilization of benefits. • Assess members’ clinical needs against established guidelines and standards. • Implement high-quality, cost-effective care based on customized population models and clinical practice guidelines. • Partner with members/families, physicians, and healthcare teams to meet member needs. • Advocate for members across sites and coordinate resource utilization. • Set priorities, plan, organize, and implement goal-directed interventions supporting self-care outcomes and transition to independent status. • Ensure care for mandated non-compliant members through utilization monitoring. • Document accurately and comprehensively according to practice standards and organization policies. • Evaluate care, solve problems, analyze variances, and participate in quality improvement. • Monitor care activities and outcomes for appropriateness and effectiveness. • Consult internal stakeholders on complex cases and escalate to internal physician resources as appropriate. • Complete other assigned functions as requested by management.

🎯 Requirements

• Requires a license as an RN, or Bachelor degree in social work, health or behavioral science. • Requires a minimum of three (3) years’ experience serving members with special needs. • Graduate level degree in Social Work or Health and Behavioral Science preferred. • Requires strong knowledge of the standards of practice for case managers. • Requires strong knowledge of managed care principles. • Requires strong knowledge of specialty population, as applicable. • Requires strong organizational skills. • Requires strong oral and written communication skills. • Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.). • Requires 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