Care Specialist III; Field Based - Hudson

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us.

We pride ourselves on our best-in‑class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

This field‑based position is accountable for the assessment and case management of members to ensure facilitation of health care services.

• Assist with implementation and facilitation of services to members in the program.
• Collaborate with member/family, physician and all members of the healthcare team, internal and external to this organization.
• Coordinate the delivery of high quality, cost‑effective care based on the members' needs and the program model supported by clinical practice guidelines established by the plan.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Interact with the member/family, physician and healthcare team.
• Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal‑directed.
• Encourage member participation and compliance in the case management program efforts.
• Utilize program case management process for goal‑directed member/family care.
• Document accurately and comprehensively based on the standards of practice and current organization policies.
• Interact and communicate effectively with member during face‑to‑face and/or telephonic contact.
• Understand fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self‑care outcomes.
• Evaluate care by problem‑solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Provide field‑based and/or telephonic case management activities specific to the case management program.
• Perform duties as assigned by management.

• Bachelor’s degree required in a health‑related or behavioral science field.
• Minimum of three (3) to four (4) years of broad clinical experience.
• Minimum of three (3) years experience in home care, discharge planning, or case management, preferably with the elderly frail population.
• Minimum of two (2) years’ experience in the managed care industry.

• Active Unrestricted NJ SW License Preferred. Candidates with a restricted license will not be considered.
• MLTSS Only:
  Prefers a minimum of two (2) years’ experience in the managed care industry.
• Additional licensing, certifications, registrations as applicable.

• Strong knowledge of the standards of practice for care managers.
• Ability to interview and assess members.
• Caseload management and casework practices.
• Human services principles for determining eligibility for benefits and services for members.
• Ability to effectively solve problems and locate community resources.
• Understanding of the needs and service delivery system for all populations in the care manager’s caseload.
• Strong knowledge of managed care principles and concepts.

• Strong organizational skills.
• Strong oral and written communication skills.
• Good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Problem‑solving and conflict resolution skills.
• Presentation skills.
• Ability to work with limited daily supervision.

This is a field‑based position; daily local travel is required.

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

$70,500 – $94,395

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