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. 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 resu...
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. This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of struc...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Responsibilities. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of struc...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position is an extended member of the departments leadership team and is responsible for the supervision and the execution of assigned audits and strategic initiatives. These responsibilities include ensuring the appropriateness of the scope, quality and execution of testing and reporting, and the identification as well as tracking...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. Responsibilities. Supports the pharmacy formulary management program, ...
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, ...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. This field based position is accountable for the assessment and case management of members to ensure facilitation of health care services. 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 ex...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Data Analyst leads the technology process for the end to end Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and works within key regulator guidelines for acceptable data submission. Using SQL and SAS programs lead the gathering of data for submissions Risk Adjustment. As the senior ana...
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. Job Summary. The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root cau...
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 ...
