Care Specialist III, Field (Field Based - Passaic County)

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

6d•$70,500 - $94,395•Onsite

About The Position

This field-based position is accountable for assessing and case managing members to facilitate health care services. The Care Specialist works with members and their families, physicians, and internal and external healthcare teams to coordinate high-quality, cost-effective care according to member needs, the program model, and the plan’s clinical practice guidelines. The role includes field-based and/or telephonic case management and requires daily local travel. Possible on-call work applies to the managed long-term support and services case management program. The position requires a bachelor’s degree in a health-related or behavioral science field, three to four years of broad clinical experience, at least three years of experience in home care, discharge planning, or case management, and at least two years of managed care industry experience. Experience with the elderly frail population is preferred. An active, unrestricted New Jersey social work license is preferred; candidates with a restricted license will not be considered. The listed salary range is $70,500–$94,395. Horizon also offers a comprehensive compensation and benefits package. Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

Bachelor’s degree in a health-related or behavioral science field.
Three to four years of broad clinical experience.
At least three years of experience in home care, discharge planning, or case management.
At least two years of experience in the managed care industry.
Strong knowledge of care management standards of practice.
Ability to interview and assess members.
Knowledge of caseload management and casework practices.
Knowledge of human services principles for determining member eligibility for benefits and services.
Ability to solve problems effectively and locate community resources.
Knowledge of needs and service delivery systems for populations in the Care Manager’s caseload.
Strong organizational skills.
Strong oral and written communication skills.
Good PC skills and ability to use Microsoft Office applications, including Excel, Access, and Word.
Good problem-solving and conflict-resolution skills.
Good presentation skills.
Ability to work with limited daily supervision.
Daily local travel is required; possible on-call work applies to the managed long-term support and services case management program.
Candidates with a restricted New Jersey social work license will not be considered.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Nice To Haves

Experience with the elderly frail population.
Active unrestricted New Jersey social work license.
Strong knowledge of managed care principles and concepts.

Responsibilities

Assist with implementation and facilitation of services to members in the program.
Collaborate with members and families, physicians, and healthcare team members within and outside the organization.
Coordinate high-quality, cost-effective care based on members’ needs, the program model, and clinical practice guidelines established by the plan.
Advocate for members and families across service sites to coordinate resource utilization and evaluate services provided.
Interact with members and families, physicians, and healthcare teams; use the care management process to set priorities, plan, organize, and implement goal-directed interventions.
Encourage member participation and compliance in case management program efforts.
Use the program’s case management process to provide goal-directed member and family care.
Document accurately and comprehensively according to standards of practice and current organizational policies.
Communicate effectively with members during face-to-face and/or telephone contacts.
Consider fiscal accountability and its impact on resource utilization while supporting optimal self-care outcomes.
Evaluate care by problem-solving, analyzing variances, and participating in quality improvement to enhance member outcomes.
Provide field-based and/or telephonic case management activities specific to the case management program.
Perform other duties as assigned by management.