Care Specialist III (Field Based - Hudson County)

Horizon Blue Cross Blue Shield of New Jersey • Hopewell, NJ

1d • $70,500 - $94,395 • Onsite

About The Position

This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services.

Requirements

• Bachelor degree required in a health related or behavioral science field.
• Requires a minimum of three (3) to four (4) years broad clinical experience.
• Requires a minimum of three (3) years experience in home care, discharge planning, or case management.
• Requires a minimum of two (2) years' experience in the managed care industry.
• MLTSS Only: Prefers a minimum of two (2) years' experience in the managed care industry.
• Requires local travel and possible on call work specific to the managed long term support and services case management program.
• Requires strong knowledge of the standards of practice for care managers.
• Requires ability to interview and assess Members.
• Requires caseload management and casework practices.
• Requires human services principles for determining eligibility for benefits and services for their members.
• Requires the ability to effectively solve problems and locate community resources.
• Requires the needs and service delivery system for all populations in the Care Manager’s caseload.
• 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 ability to work with limited daily supervision.

Nice To Haves

• Preferably with the elderly frail population.
• Prefers strong knowledge of managed care principles and concepts.
• Active Unrestricted NJ SW License Preferred.
• Candidates with a restricted license will not be considered.

Responsibilities

• Assist with implementation and facilitation of services to members in the program.
• Collaborates with 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 the members' needs and the program model supported by clinical practice guidelines established by the plan.
• 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.
• Encourages member participation and compliance in the case management program efforts.
• Utilizes program 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 effectively with member during face to face and/or telephonic contact.
• Understands fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Provides field based and/or telephonic case management activities specific case management program
• Performs duties as assigned by management.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level