Job Summary: This position is accountable for physician outreach, relationship management, issue identification and resolution, and problem avoidance. This is achieved by serving as the primary member of a team made up of people from various functional areas in the end-to-end provider experience process and is responsible to support the team for the benefit of the providers assigned to the pod/team. This includes maintaining effective relationshi...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: Assesses patient's clinical need against established guidelines a...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The Analytics Analyst II will partner with multiple customers across the Enterprise to provide more complex resolutions to analytics/data problems (i.e. descriptive statics, T testing, etc.) which require a study of situational factors, gathering information from several sources, and will provide reporting/analytic deliverables (i.e. tab...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: Responsible for the daily management of staff and inventory to ensure delivery of exceptional customer service. Evaluate strengths and weaknesses of staff in order to foster a positive working environment which includes: Daily evaluations, coaching and mentoring the business team in order to enhance staff performance levels for quality, ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: Resolve process inquiries initiated by hospitals and ancillary providers. May also perform necessary tasks on-site. Responsibilities: Review and compile monthly, quarterly, and annual reports on quality statistics in order to provide recommendations for process improvement and best practices. Partner with facility employees to identify a...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: Lead and drive the innovative transformation of Horizon’s payment landscape to enable better affordability and quality of care while also contributing to improved member and provider experience. This team will be focused on strategic work aimed at better aligning financial incentives and key network partnerships with behaviors that resul...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position ensures excellent customer service by responding in a timely, accurate and thorough manner to general requests. In addition this position is accountable for assisting in the preparation and analysis of data and for maintenance and initial reconciliation of accounts. Coordinate with Service and Billing to address customer in...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position is responsible for resolution of escalated issues and audits of daily operations of the HR Shared Services Center. This position serves as back-up to HR Shared Services Manager and will maintain confidential employee records on the Workday Human Resources Information System (HRIS). This position will provide HRMS support, c...
