RN, Data Analyst

Job not on LinkedIn

🔥 0 minutes ago

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

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

💵 $79.1k - $105.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📉 Data Analyst

👻 Ghost score 14%

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

• 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

🎯 Requirements

• 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

🏖️ Benefits

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