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. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and com

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situatio

This position is responsible for receiving verbal and written request for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad hoc reporting, correspondence and special projects. Must maintain pe

This position is responsible for leading execution and implementation activities for specific projects within HNS. This role will facilitate the development, coordination, communication, and accomplishment of short and long term business and clinical initiatives. The incumbent will act as a liaison between the department and other constituencies, will communicate and lead

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Job Description Responsibilities Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members'

This field based position is responsible for performing assessments for PCA and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members

This field based position is accountable for the assessment and case management of Dual Special Needs members using established guidelines to ensure appropriate level of care as well as developing a member centric plan of care. Responsibilities Assesses patient's clinical needs against established guidelines and/or standards to ensure that the services provided are medica

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

This senior analyst position within the Treasury Department will be responsible for conducting one or more major cash management activities. Responsibilities include cash management, liquidity projections, treasury operations, bank relationship management, cash accounting, account reconciliations, short term investing, short term borrowing and payments. The Treasury Analy

The Medical Director is a medical spokesperson for Horizon Blue Cross Blue Shield with the provider network across NJ. The Medical Director will be accountable for providing leadership, direction and daily support for their assigned region of NJ and assigned providers; the scope of activities include, but are not limited to, utilization management, care management, diseas

This position is responsible for overseeing contracts between hospitals in the Select Hospital Network or ancillary contracts (i.e. SNF's Sub acute, Home IV, etc.) and Horizon Blue Cross Blue Shield, and for ensuring that the contractual arrangement is fulfilled. Accountability's may include developing, negotiating and managing the ancillary contracting arrangements. In a

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 deliverables (i.e. tables, visual

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 deliverables (i.e. tables, visual

Responsible for the general operational oversight of multiple disciplines/units to ensure enterprise and divisional performance goals are achieved. Job Responsibilities Direct staff to ensure overall client satisfaction and appropriate level of service delivery. Develop and monitor goals for staff and provide ongoing feedback and coaching. Manage staff, including individu

Under general supervision, responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. This is an intermediate level position performing basic assignments, and may require guidance. Responsibilities Evaluate, write, and present utilization and cost containment reports. Determine or agree