Care Specialist III (Field Based - Passaic/Bergen Counties)

About the Role This field‑based position is accountable for the assessment and case management of members to ensure facilitation of health care services. You will be responsible for planning, organizing, and implementing member‑centered interventions while coordinating high quality, cost‑effective care. Responsibilities Assist with implementation and facilitation of services to members in the program. Collaborate with members/families, physicians, and the entire healthcare team, both internal and external to the organization. Coordinate delivery of high‑quality, cost‑effective care based on members’ needs and the program model supported by clinical practice guidelines established by the plan. Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided. Interact with members/families, physicians, and the healthcare team. Utilize the care management process to set priorities, plan, organize, and implement goal‑directed interventions. Encourage member participation and compliance in the case management program. Document accurately and comprehensively according to standards of practice and current organization policies. Communicate effectively with members during face‑to‑face and/or telephonic contact. Understand fiscal accountability and its impact on the utilization of resources while pursuing optimal self‑care outcomes. Evaluate care through problem solving, variance analysis, and participation in the quality improvement program to enhance member outcomes. Provide field‑based and/or telephonic case management activities specific to the case management program. Perform duties as assigned by management. Qualifications Education and Experience Bachelor’s degree required in a health‑related or behavioral science field. Minimum of 3 to 4 years broad clinical experience. Minimum of 3 years’ experience in home care, discharge planning, or case management, preferably with an elderly frail population. Minimum of 2 years’ experience in the managed‑care industry. Licensing and Certifications Active Unrestricted NJ SW License preferred. Candidates with a restricted license will not be considered. Respond to local travel and possible on‑call work specific to the managed long‑term support and services case management program. Knowledge Strong knowledge of the standards of practice for care managers. Ability to interview and assess members. Experience with caseload management and casework practices. Understanding of human services principles for determining eligibility for benefits and services. Ability to effectively solve problems and locate community resources. Knowledge of the needs and service delivery system for all populations in the care manager’s caseload. Prefers strong knowledge of managed‑care principles and concepts. Skills and Abilities Strong organizational skills. Strong oral and written communication skills. Proficiency with Microsoft Office applications (Excel, Access, Word, etc.). Problem‑solving and conflict‑resolution skills. Presentation skills. Ability to work with limited daily supervision. Travel This field‑based position requires daily local travel. The role may also involve on‑call work. Salary and Benefits Salary Range: $70,500 - $94,395. Benefits include comprehensive health benefits (Medical/Dental/Vision), retirement plans, generous PTO, incentive plans, wellness programs, paid volunteer time off, tuition reimbursement, and more. Disclaimer Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware. This job summary is intended to indicate the general nature and level of work performed by colleagues in this classification. It is not intended to be a comprehensive inventory of all duties, responsibilities, and qualifications required. Equal Opportunity Statement 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. #J-18808-Ljbffr 100 Horizon Healthcare Services, Inc