MLTSS Care Specialist, Field Based (Cumberland County)

Horizon Healthcare Services•Hopewell, NJ

20d•Onsite

About The Position

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 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.
Active Unrestricted NJ SW License Preferred.
Candidates with a restricted license will not be considered.
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.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Nice To Haves

Preferably with the elderly frail population.
MLTSS Only: Prefers a minimum of two (2) years' experience in the managed care industry.
Prefers strong knowledge of managed care principles and concepts.

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.