Horizon Blue Cross Blue Shield of New Jersey · 1 day ago
Care Manager I, Specialty Programs
Hopewell, NJ
Full-time
Onsite
Mid Level
$70K/yr - $94K/yr
3+ years expHorizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health and has been a leader in health solutions for over 90 years. The Care Manager I – Specialty Programs is responsible for care coordination duties and planning transitions for specialty populations, ensuring efficient utilization of benefits and high-quality care delivery.
Health Care
Responsibilities
Assess member’s clinical need against establish guidelines and/or standards for specialty population-based members
Implement the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan
Partner with the member/family, physician, and all members of the healthcare team to ensure the member’s needs are met, internal and external to this organization. Advocate for the member among various sites to coordinate resource utilization
Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status
Ensure care for mandated non-compliant members through the monitoring of utilization
Document accurately and comprehensively based on the standards of practice and current organization policies
Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes
Monitor member’s care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness
Consult with internal stakeholders on complex cases and escalate as appropriate to internal physician resources
Complete other assigned functions as requested by management
Qualification
Required
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
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
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Preferred
Graduate level degree in Social Work or Health and Behavioral Science preferred
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products.
5001-10000 employees
H1B Sponsorship
Horizon Blue Cross Blue Shield of New Jersey has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (7)
2024 (7)
2023 (6)
2021 (1)
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
Company data provided by crunchbase