Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This field based position is responsible for performing assessments for PCA and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized. Responsibilities. Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The COB (Coordination of Benefits) Member Management function will be solely accountable for maintaining COB files and specifically ensure member data is kept consistent, accurate and current for the enterprise. Load and maintenance of member COB files. Perform outreach to members to obtain COB information (LOI-s, phone calls, written c...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Risk Adjustment Vendor & Performance Analyst is responsible for supporting the management and administration of risk adjustment vendors and performance monitoring of those vendors and the overall risk adjustment department. This includes managing all data transferred to and from Risk Adjustment vendors as well as other external and ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. Horizon BCBS is seeking a motivated and detail-oriented intern to join our Office of Information Governance and Privacy. This role provides an excellent opportunity to gain hands-on experience in the fields of data privacy, information governance, including AI governance, and compliance while working in a dynamic and fast-paced environm...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. Horizon BCBS is seeking a motivated and detail-oriented intern to join our Office of Information Governance and Privacy. This role provides an excellent opportunity to gain hands-on experience in the fields of data privacy, information governance, including AI governance, and compliance while working in a dynamic and fast-paced environm...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Enterprise Applications Manager will manage a team of technical resources responsible for the development, implementation, and production support of Cloud Technology. The incumbent will be responsible for overseeing the successful implementation and building an operating model for an enterprise application. The candidate must have e...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position is accountable for providing support to the field based Care Managers (RN II and Care Specialist III). In addition, Clinical Care Associates serve as the first point of contact for our members looking for service and/or provider information as well as members or providers requesting authorizations and denials of services. ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. Horizon BCBS seeks a self-directed Communications/Marketing Intern for the Proposal Development Team with a passion for collaboration, writing, editing, desktop publishing and creative problem-solving. The intern will actively contribute to meaningful projects, work closely with Horizon staff and develop content/sales collaterals. Inter...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Self-Direction PPP Support Coordinator is responsible for conducting quarterly in-person evaluations on members enrolled in the Personal Preference Program. During these quarterly meetings, the Support Coordinator is responsible for all workforce functions including budgeting, back-up plan, capacity planning, forecasting, safety pla...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Care Manager I – Specialty Programs is responsible for performing care coordination duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care for specialty populations. This position implements interventions to ensure efficient utilization of benefits. Job...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Care Manager II– Specialty Programs serves as mentor/preceptor/trainer to new care managers in the CCDM department. The incumbent will perform duties and facilitate care management as assigned. This position serves as the subject matter expert for their specialized population and will actively participate in projects and committees....
