Care Specialist III – Field Based

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

📋 Description

• Evaluate and manage cases for members to enhance access to healthcare services

• Aid in the execution and facilitation of member services within the program

• Collaborate with members and their families, physicians, and both internal and external healthcare teams

• Organize high-quality, cost-efficient care tailored to member needs, program models, and clinical practice guidelines

• Advocate on behalf of members and families across various locations to optimize resource usage and assess services

• Set priorities, strategize, organize, and execute goal-oriented interventions

• Promote member involvement and adherence in case management initiatives

• Maintain accurate and thorough documentation in line with practice standards and organizational policies

• Engage with members through in-person and telephone communication

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

• Conduct field-based and/or telephonic case management activities

• Undertake tasks as assigned by management

• Travel locally on a daily basis as required by this field-based role

⛳️ Requirements

• A Bachelor’s degree is mandatory

• A minimum of three (3) to four (4) years of extensive clinical experience is required

• At least three (3) years of experience in home care, discharge planning, or case management is necessary

• Experience with the elderly frail population is preferred

• A minimum of two (2) years’ experience in the managed care sector is desired

• An active unrestricted NJ RN/SW License is preferred; candidates with a restricted license will not be considered

• Local travel and potential on-call duties are required

• Comprehensive knowledge of case management practice standards is essential

• Strong understanding of managed care principles and concepts, including HEDIS, is necessary

• Excellent organizational skills are required

• Strong oral and written communication abilities are essential

• Proficiency in PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.) is important

• Strong problem-solving and conflict resolution skills are necessary

• Good presentation skills are a must

• Ability to work with minimal daily supervision is required

• 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