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. 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 has oversight for the analysis and translation of business needs into business/technical requirements. Leads teams and other resources to ensure alignment of technical solutions with business requirements for complex issues (quantity and magnitude). Acts as a representative of IT to the Enterprise regarding Enterprise Init...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position is responsible for monitoring, supporting, and participating in the development/enhancements of distributive system management platforms. Responsibilities. Resolve issues through level 3 in server, operating systems or other software under the control of the Distributed Systems management team. Provide guidance to junior i...
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. This position is responsible for implementing various initiatives that cross department lines in support of HCM's strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for ensuring compliance with accrediting, state and fe...
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. The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi-disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that del...
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. 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 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....
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Director, Infrastructure Architecture is a key member of the IT Leadership team responsible for strategic planning and design of technology services, including the overall infrastructure design and build of standard and custom elements of various projects and services. This role works as a leader within the Infra organization, worki...
