Care specialist iii, field (field based - passaic county)

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.

About the Role

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

What You'll Do

• Assist with implementation and facilitation of services to members in the program.
• Collaborates with member/family, physician and all members of the healthcare team, internal and external to this organization.
• Coordinates 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.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Interacts with the member/family, physician and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed.
• Encourages member participation and compliance in the case management program efforts.
• Utilizes program case management process for goal directed member/family care.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates effectively with member during face to face and/or telephonic contact.
• Understands fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Provides field based and/or telephonic case management activities specific case management program.
• Performs duties as assigned by management.

What You Bring

Education/Experience:

• Bachelor degree required in a health related or behavioral science field.
• Requires a minimum of 3 to 4 years broad clinical experience.
• Requires a minimum of 3 years experience in home care, discharge planning, or case management. Preferably with the elderly frail population.
• Requires a minimum of 2 years' experience in the managed care industry.
• MLTSS Only: Prefers a minimum of 2 years' experience in the managed care industry.

Additional licensing, certifications, registrations:

• Active Unrestricted NJ SW License Preferred. Candidates with a restricted license will not be considered.
• Requires local travel and possible on call work specific to the managed long term support and services case management program.

Knowledge:

• Requires strong knowledge of the standards of practice for care managers.
• Requires ability to interview and assess Members.
• Requires caseload management and casework practices.
• Requires human services principles for determining eligibility for benefits and services for their members.
• Requires the ability to effectively solve problems and locate community resources.
• Requires the needs and service delivery system for all populations in the Care Manager’s caseload.
• Prefers strong knowledge of managed care principles and concepts.

Skills and Abilities:

• 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 good presentation skills.
• Requires ability to work with limited daily supervision.

Travel:

This is a field based position, daily local travel is required.

Why Horizon?

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!

Salary Range:

$70,500 - $94,395

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

Disclaimer:

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

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.