Care Manager II, Specialty Programs-Hunterdon/Somerset NJ Counties or Southern NJ Field Based

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

Job Responsibilities:

• Responsible for performing care manager duties using established guidelines to ensure appropriate level of care for our members while preparing new hires to independently transition to the care manager role.
• Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Evaluate the appropriateness and efficiency of all services designed to meet the member's needs. Coordinates and assists in implementation of care plan for members.
• Act as subject matter expert for respective area for mentoring/ preceptor /training/remediation classes.
• Conduct training and presentations in team meetings and facilitate ad-hoc training activities.
• Participate in department workgroups to drive internal process changes and efficiencies.
• Provide reports and feedback on mentees progress to assigned Supervisor as part of the orientation process; assist in the development of plan to identify opportunities for improvement.
• Act as a subject matter expert and participate in user acceptance testing for medical management system. Evaluates care management processes by problem solving, analyzing variances, and participating in the quality improvement program to enhance trained staff outcomes. Participate in audit activities including IPRO, NCQA, or any other ad-hoc state audits.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• Requires a license as an RN, or Bachelor degrees in social work, health or behavioral science.
• Graduate level degree in Social Work or Health and Behavioral Science preferred.
• Requires a minimum of five (5) years' experience working with special needs.

• Requires strong knowledge of the standards of practice for case managers.
• Requires strong knowledge of managed care principles.
• Requires advanced knowledge of specialty population, as applicable.

• Requires strong organizational skills.
• Requires presentation skills and ability to conduct trainings to teams.
• Requires the ability to provide constructive feedback and mentorship to team members.
• 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.

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.