MLTSS Field Care Specialist III at Horizon Blue Cross Blue Shield of New Jersey in Newark, New Jersey

Posted in Other 2 days ago.





Job Description:

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 external to this organization.

  • Coordinates the delivery of high quality, cost-effective care based on the members' needs and the program model supported by clinical practice guidelines established by the plan.

  • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.

  • Interacts with the member/family, physician and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed.

  • Encourages member participation and compliance in the case management program efforts.

  • Utilizes program case management process for goal directed member/family care.

  • Documents accurately and comprehensively based on the standards of practice and current organization policies.

  • Interacts and communicates effectively with member during face to face and/or telephonic contact.

  • Understands fiscal accountability and its impact on the utilization of resources, while proceeding to optimal self-care outcomes.

  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.

  • Provides field based and/or telephonic case management activities specific case management program

  • Performs duties as assigned by management.

Experience/Education:


  • Requires a Bachelor's degree from an accredited college or university.

  • Requires a minimum of three (3) to four (4) years broad clinical experience.

  • Requires a minimum of three (3) years experience in home care, discharge planning, or case management. Preferably with the elderly frail population.

  • Requires current licensure in the professional discipline appropriate to the care management program (e.g. Social Work or Behavioral Health.)

  • Requires a minimum of two (2) years' experience in the managed care industry.

  • MLTSS Only: Prefers a minimum of two (2) years' experience in the managed care industry.


Additional licensing, certifications, registrations:


  • No Regulatory Requirement; Active Unrestricted NJ RN/SW License Preferred

  • Requires local travel and possible on call work specific to the managed long term support and services case management program.


Knowledge:


  • Requires strong knowledge of the standards of practice for case managers.

  • Requires strong knowledge of managed care principles and concepts including Health Plan Employer Data and Information Sheet (HEDIS).


Skills and Abilities:


  • Requires strong organizational skills.

  • Requires strong oral and written communication skills.

  • Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)

  • Requires good problem solving and conflict resolution skills.

  • Requires good presentation skills.

  • Requires ability to work with limited daily supervision


Travel:


  • This is a field based position, daily local travel is required.

  • Requires a car with valid New Jersey State License and Insurance

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.