Horizon Blue Cross Blue Shield of New Jersey

Account Consultant II - National Accts

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 7 hours ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 2-5 yrs exp 💼 Others

The Account Consultant II manages relationships with National 100+ accounts to maximize sales, retention, and business expansion. Key duties include facilitating client presentations, analyzing data for cost-saving designs, and resolving complex service issues.

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Care Transformation Coach

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 15 hours ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $87300 - $119K per year ⭐ 5-10 yrs exp 💼 Teaching

The Care Transformation Coach supports value-based healthcare programs by facilitating the transition of multidisciplinary teams and implementing innovative care delivery strategies. They analyze performance data and design action plans to improve healthcare quality and reduce costs for strategic partners.

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Group Underwriter I

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a day ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 0-2 yrs exp 💼 Finance

Develop and issue renewal rates for group sizes of 51+ while managing a book of business independently. Analyze account metrics and marketplace data to provide rating recommendations and support the sales team.

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RN II/ Case Manager -REMOTE-State Health Benefits

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a day ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for performing RN duties to ensure appropriate levels of care and planning transitions within the continuum of care. This includes assessing clinical needs, coordinating medical services, and serving as a subject matter expert for projects and committees.

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Mgr, Post Service Clinical Claims Review

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 3 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $123K - $167K per year ⭐ 10+ yrs exp 💼 Legal

Directs operational functions for post-service claims reviews, clinical coding, and reimbursement policies across Commercial, Medicaid, and Medicare products. Leads quality initiatives and performance evaluations to optimize medical cost savings and operational efficiency.

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RN II

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 4 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for performing RN duties to ensure appropriate levels of care and planning transitions within the continuum of care. This includes assessing clinical needs against guidelines, coordinating medical services, and serving as a mentor to new staff.

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Managed Care Coordinator II (Bilingual - Spanish Speaking)

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 5 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $50100 - $67095 per year ⭐ 2-5 yrs exp 💼 Healthcare

Acts as a liaison between members, physicians, and clinical staff to coordinate care and handle escalated non-clinical issues. Responsibilities include reviewing service requests, authorizing services based on scripts, and assisting members with provider searches and health assessments.

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RN I

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 6 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for assessing patient clinical needs against guidelines to ensure appropriate levels of care and length of stay. Coordinates high-quality, cost-effective care and manages transitions across the continuum of care for members.

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Quality Auditor II

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 7 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Finance

Conducts quarterly and monthly file audits to ensure clinical operations comply with NCQA, URAC, and CMS regulatory standards. Analyzes audit outcomes to identify error trends and provides recommendations for process improvement and staff education.

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Digital Products Reporting Manager

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 7 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $97800 - $133K per year ⭐ 5-10 yrs exp 💼 Others

Lead the reporting and analytics strategy for digital products to provide data-driven insights for senior management and external clients. Partner cross-functionally to measure the effectiveness of digital projects and optimize member experience goals.

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RN II - Primary Nurse Care

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 7 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

Perform RN duties for the Primary Nurse population, focusing on clinical assessments and developing member-centric plans of care. Coordinate high-quality, cost-effective care across the continuum and mentor new nursing staff.

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Med Dir., Prov Perf & Clin Transf

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 10 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $214K - $297K per year ⭐ 10+ yrs exp 💼 Others

Responsible for designing and delivering provider education and performance management initiatives to improve patient experience, population health, and affordability. The role leads a team of clinical transformation specialists to drive value-based care goals and provider engagement.

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Mgr, Growth Operations

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 11 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $123K - $167K per year ⭐ 5-10 yrs exp 💼 Marketing

Lead a growth operations team focused on pipeline management, BANT qualification, and CRM hygiene to scale the enterprise growth engine. Coordinate executive-level meeting generation and orchestrate complex enterprise deals across cross-functional teams.

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Housing Specialist

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 12 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 2-5 yrs exp 💼 Others

Identify and secure community-based housing for MLTSS, SNP, and Medicaid members while developing a broader housing strategy. Act as the central housing expert providing education and assistance to care managers and relevant staff.

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Clinical Care Coordinator

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 12 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $56200 - $75285 per year ⭐ 2-5 yrs exp 💼 Healthcare

This role supports field-based Care Managers and RNs by facilitating healthcare services and scheduling appointments for members. It involves coordinating cost-effective care, monitoring compliance through reports, and maintaining accurate documentation within a member-centric plan.

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RN II- CASE MGR.TRANSPLANT(REMOTE) HCC

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 13 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Transplant Case Manager coordinates the entire transplant journey, acting as a primary advocate to navigate medical, social, and financial barriers. Responsibilities include assessing clinical needs, monitoring care effectiveness, and collaborating with multidisciplinary teams to ensure high-quality, cost-effective outcomes.

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RN II, Primary Nurse Care

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 15 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

Perform RN duties for the primary nurse population by developing member-centric plans of care and managing transitions in the continuum of care. Outreach to high-risk members to engage them in preventative care and serve as a mentor to new nursing staff.

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CPC Investigator

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a month ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 2-5 yrs exp 💼 Others

Perform audits and coding oversight of medical records to ensure compliance with CPT, HCPCS, and ICD-10 guidelines. Conduct low-level fraud investigations and manage pended claims to meet service level agreements for ASO and Blue Card accounts.

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Quality Mgmt Specialist

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a month ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $97800 - $133K per year ⭐ 5-10 yrs exp 💼 Others

Supports the Quality Management department through project planning, implementation, and the establishment of policies for Government and Commercial programs. Analyzes complex data to improve health plan quality ratings and member experience through CAHPS coaching and provider action plans.

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Business Process Engineer Sr. Process Design Specialist II

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a month ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $109K - $149K per year ⭐ 10+ yrs exp 💼 Software Development

Lead complex process improvement initiatives to reduce costs and complexity across the enterprise using Lean Six Sigma methodologies. Act as a strategic consultant to business leadership, developing business cases and mentoring staff toward Green and Black Belt certifications.

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RN II - Oncology Case Manager-REMOTE BASED

Horizon Blue Cross Blue Shield of New Jersey · Full Time · a month ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for performing RN duties to ensure appropriate levels of care and planning transitions within the continuum of care for oncology patients. This includes assessing clinical needs against guidelines, coordinating medical services, and serving as a mentor to new staff.

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Investigator II

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 2 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $63000 - $84420 per year ⭐ 2-5 yrs exp 💼 Others

The investigator is responsible for conducting analytical and investigative activities to detect and resolve suspected fraud related to claims, enrollment, and accounting. They will manage a caseload, assemble evidence for potential litigation, and represent the company in legal proceedings and settlement negotiations.

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Account Manager IV

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 2 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $125K - $151K per year ⭐ 10+ yrs exp 💼 Sales

The Account Manager is responsible for retaining existing labor market accounts and selling additional product lines while serving as the primary relationship manager. They coordinate across internal teams to ensure operational excellence, compliance, and the delivery of strategic support to fund trustees and administrators.

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National Programs Analyst

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 3 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $63000 - $84420 per year ⭐ 2-5 yrs exp 💼 Others

The National Programs Analyst coordinates the implementation of various Association initiatives and projects to support strategic and operational goals. This includes monitoring compliance, resolving claims issues, and collaborating with IT and other divisions.

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RN I

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 4 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $70500 - $94395 per year ⭐ 2-5 yrs exp 💼 Healthcare

This role involves performing RN duties using established guidelines to ensure appropriate levels of care and planning for care transitions, including assessing clinical needs against standards for inpatient stays. Responsibilities also cover evaluating medical services, coordinating care plans, monitoring services outside the network, and advocating for members across various care sites.

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RN II - Primary Nurse Care

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 4 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $79100 - $105K per year ⭐ 2-5 yrs exp 💼 Healthcare

This role involves performing RN duties for the Primary Nurse population, ensuring appropriate levels of care, planning care transitions, and developing member-centric care plans based on established guidelines. Primary Nurses will outreach to high-risk members, engage them in preventative care, and perform assigned care management duties, potentially serving as a mentor to new staff.

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RN Case Manager-ONCOLOGY (REMOTE)

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 8 months ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $77900 - $104K per year ⭐ 2-5 yrs exp 💼 Healthcare

The RN Case Manager is responsible for assessing patients' clinical needs and coordinating care to ensure appropriate levels of care. This role includes monitoring services, advocating for members, and collaborating with multidisciplinary teams.

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