Care Manager I – Specialty Programs

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Carry out care coordination tasks following established protocols to guarantee an appropriate level of care and facilitate transitions within the continuum of care for specialized populations.

• Evaluate members’ clinical requirements against set guidelines and/or standards.

• Deliver high-quality, cost-efficient care based on tailored population models and clinical practice standards.

• Collaborate with members/families, physicians, and healthcare teams to address member needs and manage resource utilization effectively.

• Prioritize, plan, organize, and execute goal-oriented interventions that promote self-care and facilitate a transition to independent living.

• Ensure compliance in care for mandated non-compliant members through careful utilization monitoring.

• Accurately and thoroughly document practices in accordance with standards of care and organizational policies.

• Assess care, troubleshoot issues, analyze discrepancies, and engage in quality improvement initiatives.

• Supervise care activities and outcomes for suitability and effectiveness across various service sites and networks.

• Consult with internal stakeholders on intricate cases and escalate matters to internal physician resources as necessary.

• Fulfill additional functions as assigned by management.

⛳️ Requirements

• Must possess a license as a Registered Nurse (RN) or a Bachelor’s degree in social work, health, or behavioral science.

• A graduate-level degree in Social Work or Health and Behavioral Science is preferred.

• Requires at least three (3) years of experience working with members who have special needs.

• Strong understanding of the standards of practice for case management is essential.

• In-depth knowledge of managed care principles is required.

• Familiarity with specialty populations, as applicable, is necessary.

• Exceptional organizational skills are required.

• Strong verbal and written communication skills are essential.

• Proficient PC skills and the ability to use Microsoft Office applications (Excel, Access, Word, etc.) are required.

• Effective problem-solving and conflict resolution skills are necessary.

• A valid New Jersey State Driver's License and insurance is required for certain positions.

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

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement