Clinical Care Coordinator

Horizon BCBSNJ Care Management Support

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.

About the Role

This position is accountable for assisting and extending support to the field based Care Managers and RN I. This position also ensures facilitation of health care services within a member centric plan of care, under the direction and supervision of an RN.

What You'll Do

• Ensure timely appointments and scheduling.
• Assist with implementation and facilitation of services members.
• Ensure timely member follow up. Interacts and communicates effectively with the member during telephonic contact.
• Encourages member participation and compliance in the program.
• Assist with all calls to members. Coordinates the delivery of high quality, cost-effective care based on the members- needs and the managed long term support and services model supported by clinical practice guidelines established by the plan.
• Run reports to monitor compliance on scheduled services to ensure timely delivery of services and required follow up.
• Utilizes care management process for goal directed member care.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Provides telephonic assistance for activities specific to the program.

What You Bring

Education/Experience:

• High School Diploma/GED required.
• Prefers healthcare industry experience.
• Requires a minimum of one (1) year experience in home care, discharge planning, or case management. Preferably with the elderly frail population.
• Prefer a minimum of one (1) year experience in the managed care industry.

Knowledge:

• Requires knowledge of the standards of practice for coordination of services, and delivery of services.
• Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS).

Skills and Abilities:

• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills, knowledge of working with a Medical Management system for electronic medical records 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.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!

Salary Range: $56,200 - $75,285

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

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

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.