Horizon Blue Cross Blue Shield of New Jersey · 6 hours ago
Care Specialist III
United States
Full-time
Remote
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 Specialist III is responsible for managing high-risk cases through effective interventions and ensuring efficient utilization of benefits.
Health Care
Responsibilities
Conducts high-level assessment and planning for selected population-based members
Collaborates with the 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 a customized population
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 toward self-care outcomes, and the transition to independent status
Encourages member participation and compliance in the care management program efforts
Utilizes population-based 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, either telephonically and/or on site striving for continuity and efficiency as the member is managed along the continuum of care
Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes
Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes
Provides telephonic and/or field based population case management activities specific to the care management program
Provides guidance and support to less experienced Care Specialists
Qualification
Required
High School Diploma/GED required
Requires a minimum of three (3) years broad clinical experience
Requires a minimum of two (2) years experience in home care, discharge planning and/or case management
Requires a minimum of three (3) years experience in the managed care industry
Requires strong knowledge of the standards of practice for case managers
Requires strong knowledge of managed care principles and concepts including Health Plan
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 Project Management Skills
Requires a car with valid New Jersey State License and Insurance for certain positions
Preferred
Bachelor degree preferred or relevant experience in lieu of degree
Active Unrestricted NJ SW License or New Jersey Certified Social Worker (CSW.) or New Jersey License Social Worker (LSW) or License Clinical Social Worker (LCSW) preferred
Prefers CCM certification
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
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
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