Care Transformation Coach

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

About the Role

The Horizon care transformation team is responsible for working directly with providers of care to implement and sustain innovative programs that emphasize value-based care within the Healthcare delivery system in New Jersey. The transformation team works in a hands-on manner to support Horizons Value-Based programs, provide exceptional service to the customer and contain medial claims cost. The Care Transformation Coach will support Horizons Value-Based programs by facilitating and tracking the transition of multidisciplinary internal and external healthcare teams against established requirements and standard processes, by working internally to enhance these programs and externally to facilitate program implementation. Serves as a resource for and advisor to healthcare providers and Horizon staff from all departments.

What You'll Do

Responsibilities:

• Performs data interpretation and analysis, performance reviews and readiness assessments to determine strategies, workflows and tactics to result in care transformation to meet performance indicators and achieve the triple aim.

• Designs high-quality action and/or project plans to drive value-based initiatives, including the development of projects to support strategic partners with the identification of needs, project implementation, monitoring and refinement.

• Focuses strategically with stakeholders to assist with the identification and prioritization of goals to enhance care delivery, cost reduction and improve quality.

• Chairs or participates on specific internal and external core teams and/or work streams to offer background expertise to support transformation efforts for strategic partners.

• Leads the creation and facilitation of individual, customized Value-Based trainings, including in-services, Webinars. Offers train the trainer sessions to expand transformation activities across a broader audience.

• Creates and facilitates the appropriate use of educational materials considering health literacy for internal and external partners (e.g. Value-Based programs, motivational interviewing, etc.) to drive learning collaboration and healthcare delivery transformation to focus on population health.

• Develops and implements the use of customized tools to support performance improvement.

• Examines and conveys data, project findings/results and action plans to internal and external stakeholders.

• Utilizes best practices to collaborate and optimize continuous improvement processes among Value-Based partners.

• Works and builds upon collaboratively with internal and external stakeholders to identify cultural change needs that can support synergy among the value-based programs. Participates with internal and external teams to develop and communicate key performance indicators to monitor adherence to best practices and achievement of member outcomes.

• Maintains superior relationships with various strategic partners, including health care providers, facilities and other health care stakeholders throughout New Jersey. Interaction with partners may occur at all levels within an organization including physicians, nurses and executives.

• Champions collaborative cross-departmental and cross-team environment and communication between transformation teams and other Horizon departments, including health affairs, network management, sales, analytics and government programs.

• Utilizes clinical best practices, based on research, national pilots and Horizon experience, for internal teams and external customers.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree in Healthcare Management or related field preferred or relevant experience in lieu of degree.

• Requires minimum five (5) years clinical experience in a healthcare setting: health plan, hospital, physician practice.

• Prefer an RN, Licensed clinical social worker, or Master of Public Health.

• Requires direct experience with disease management/preventative management programs/population health.

• Requires direct experience with using data analysis to drive population health management and process improvement.

• Requires experience in continuous quality improvement/quality management/rapid cycle improvement.

• Requires direct experience with behavioral coaching or motivational interviewing preferred.

• Prefer project management experience Additional licensing, certifications, registrations: Licensed RN or SW preferred Requires an active NJ Drivers License

Knowledge:

• Requires basic knowledge of health plan activities including Utilization Management (UM), the CCM process and Disease Management/Population Based CM, basic claims processing, contracting and enrollment -

• Requires knowledge of health care systems, practice and hospital based care delivery, fundamentals of population health, value based payment models and medical documentation.

Skills:

• Proven ability to influence without authority and the ability to achieve results through others in a decentralized organization without formal reporting relationships.

• Strong facilitator skills in leading cross-functional teams to achieve improvements and taking initiative to finding solutions to difficult or sensitive problems, including asking probing questions.

• Requires effective, professional communication skills both verbal and written.

• Strong public speaking and presentation skills.

• Requires excellent interpersonal skills and ability to work with all levels.

• Requires project management skills.

• Must be proficient in use of personal computers and supporting software in a windows based environment including MS Office Products (Word, Excel, Outlook, PowerPoint).

• Strong organizational skill and ability to set priorities.

• Innovative, critical thinker and problem solver.

• Flexible and adaptable to change.

• Works well independently as well as in a team environment.

• Exercises sound judgment.

• Takes initiative in finding solutions to difficult situations and addresses challenges.

Travel:

• Significant travel within the state of NJ.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.  We believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$87,300 - $119,070

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.