Horizon Blue Cross Blue Shield of New Jersey

Pharmacy Specialist I

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $44600 - $59745 per year ⭐ 2-5 yrs exp 💼 Healthcare

The Pharmacy Specialist I is responsible for processing prior authorization requests and coordinating pharmacy services benefits while ensuring compliance with regulatory standards. They also manage telephonic interactions with members and providers to facilitate formulary compliance and resolve claim issues.

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Care Manager I, Specialty Programs

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

Horizon Blue Cross Blue Shield of New Jersey

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

The Care Manager I is responsible for performing care coordination duties and implementing interventions to ensure efficient utilization of benefits for specialty populations. They partner with members, families, and healthcare teams to assess clinical needs and facilitate transitions to appropriate levels of care.

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Associate Chief Medical Officer

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $269K - $374K per year ⭐ 10+ yrs exp 💼 Healthcare

The Associate Chief Medical Officer provides executive leadership for clinical strategy, medical policy, and utilization management to ensure high-quality, cost-effective healthcare delivery. They act as a key spokesperson and liaison, building relationships with providers and regulators while overseeing clinical quality programs and performance metrics.

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RN II- CASE MGR.Transplant/ICU/Critical Care-(REMOTE)

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

The Transplant Case Manager acts as a primary advocate and care coordinator, managing clinical caseloads and performing telephonic triage throughout the transplant journey. They also serve as a subject matter expert, mentor new staff, and coordinate with multidisciplinary teams to ensure high-quality, cost-effective care.

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Managed Care Coordinator II

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

Horizon Blue Cross Blue Shield of New Jersey

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

This role supports clinical operations by acting as a liaison between members, providers, and internal teams to coordinate care and verify benefits. Responsibilities include managing service requests, conducting initial screenings for precertification, and assisting members with case management and preventative care navigation.

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Managed Care Coordinator II

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

Horizon Blue Cross Blue Shield of New Jersey

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

This role acts as a liaison between members, providers, and clinical operations to coordinate care and verify benefits. Responsibilities include processing service requests, handling escalated inquiries, and supporting case management activities.

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Managed Care Coordinator I

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $44600 - $59745 per year ⭐ 0-2 yrs exp 💼 Healthcare

The Managed Care Coordinator supports clinical operations by acting as a liaison between members, providers, and internal teams to coordinate benefits and care. Responsibilities include screening service requests, managing case documentation, and engaging members in health assessments and preventive care activities.

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Claims Bus Tech Analyst II

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

Horizon Blue Cross Blue Shield of New Jersey

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

The analyst will coordinate technical requirements across the Service Division to support automation and efficiency projects aimed at improving claims timeliness and quality. They will also manage claims stop governance, perform user acceptance testing, and collaborate with IT and vendors to implement system enhancements.

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Actuarial Analyst III

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $87300 - $119K per year ⭐ 2-5 yrs exp 💼 Finance

The Actuarial Analyst III performs advanced financial modeling, pricing, and forecasting to support organizational business decisions. They are responsible for analyzing healthcare utilization trends and maintaining recurring actuarial reports and dashboards.

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Network Contracting Acct Spec

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

Horizon Blue Cross Blue Shield of New Jersey

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

Lead and facilitate network provider negotiations across various medical lines of business to ensure alignment with strategic and budget objectives. Manage the implementation, maintenance, and compliance of provider contracts and payment models.

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Mgr, Actuarial II

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $125K - $170K per year ⭐ 5-10 yrs exp 💼 Others

Lead the No Surprises Act (NSA) actuarial team by developing forecasts, reserves, and financial analyses. Partner with cross-functional teams to improve data collection and communicate financial risks and recommendations to senior leadership.

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RN I, PCA/MDC/DSNP (Field-Based - Atlantic County)

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

Horizon Blue Cross Blue Shield of New Jersey

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

This field-based role involves performing clinical assessments for PCA and MDC services to ensure medically appropriate care and service authorization. The position coordinates care across the continuum, monitors patient outcomes, and advocates for members while maintaining fiscal accountability.

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Care Manager I, Specialty Programs

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

Horizon Blue Cross Blue Shield of New Jersey

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

The role involves performing care coordination and implementing interventions for specialty populations to ensure high-quality, cost-effective care. Responsibilities include assessing clinical needs, partnering with healthcare teams, and monitoring member outcomes to facilitate transitions to independent status.

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RN I

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

Horizon Blue Cross Blue Shield of New Jersey

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

The role involves assessing patient clinical needs against guidelines to ensure appropriate levels of care and length of stay. It also requires coordinating high-quality, cost-effective care and managing transitions across the continuum of care.

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OON Mandate Negotiation Analyst-1

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $58029 - $77074 per year ⭐ 5-10 yrs exp 💼 Others

Manage the resolution of out-of-network billing disputes and negotiate reimbursement for inadvertent or involuntary services. Ensure all cases are handled within regulatory timeframes and perform root cause analysis to prevent future escalated complaints.

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Sr. Call Center Service Assoc

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 14 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $52787 - $70172 per year ⭐ 2-5 yrs exp 💼 Support

Resolve complex customer inquiries and escalated issues through investigation and documentation. Coach junior staff and serve as a liaison between internal and external operational contacts to ensure high service levels.

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Accounting/Financial Vendor Analyst

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 18 days ago

Horizon Blue Cross Blue Shield of New Jersey

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

The analyst will assess vendor data to calculate financial penalties and support contract negotiations through cost analysis and budget forecasting. They are also responsible for validating invoice submissions and performing credit/reimbursement true-up analyses.

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RN II - Primary Nurse Care

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 20 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 serve as a mentor to new nursing staff.

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Specialist, Change Mgt & Business Readiness

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 24 days ago

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $109K - $149K per year ⭐ 5-10 yrs exp 💼 Others

Lead enterprise change management and adoption planning for service transformation initiatives across Operations. Ensure organizational readiness, stakeholder alignment, and sustainable adoption of business and technology changes.

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Sr. Analyst, Service

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 24 days ago

Horizon Blue Cross Blue Shield of New Jersey

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

Lead end-to-end process analysis and redesign to improve operational performance and customer experience. Partner with technology and business stakeholders to automate service delivery and ensure operational readiness for new system implementations.

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Actuarial Analyst II

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 💼 Finance

The role focuses on Commercial Trend Forecasting, evaluating the financial impact of benefit changes and pricing studies. It involves analyzing legislative changes and conducting experience studies to identify cost drivers and utilization patterns.

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Actuarial Analyst III

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $102K - $140K per year ⭐ 2-5 yrs exp 💼 Finance

The role supports premium rate development and pricing strategies for the Large Group market through financial impact studies and predictive modeling. It also ensures regulatory compliance, including Mental Health Parity reviews and state/federal rate filings.

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Actuarial Analyst II

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 💼 Finance

Perform actuarial and data analytics for risk-adjusted business lines including ACA, Medicare Advantage, and Medicaid. Develop insights to guide risk adjustment strategy, financial projections, and pricing efforts.

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Account Manager III

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

Horizon Blue Cross Blue Shield of New Jersey

🌎 United States 💵 $92100 - $120K per year ⭐ 5-10 yrs exp 💼 Sales

The role focuses on the conservation of existing public market accounts and selling additional product lines to maximize retention. Responsibilities include negotiating contract terms, conducting client workshops, and ensuring stakeholders are informed of regulatory issues.

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Digital Products Reporting Manager

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 2 months 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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Med Dir., Prov Perf & Clin Transf

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 2 months 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 · 2 months 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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Quality Mgmt Specialist

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 2 months 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 · 3 months 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 Case Manager-ONCOLOGY (REMOTE)

Horizon Blue Cross Blue Shield of New Jersey · Full Time · 9 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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