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

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. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the l

Responsible for the creation and execution of quality audit and coaching plans for new hires, existing employees, enterprise projects and service initiatives. Align resources to the business teams and vendor partners to support daily functions, nesting, and identification of trends, gap analysis and remediation. Monitor team performance against enterprise and divisional g

This position is responsible for developing programs that enhance and support the Corporate Social Responsibility team's vision, strategic planning, financial management and funding operations that support the overall objectives of Horizon Blue Cross Blue Shield of New Jersey. This positon will oversee the Horizon Cares programs, Horizon's internal platform of benefits th

This position is accountable for assisting and extending support to the MLTSS RN/MLTSS Care Specialist working in the field. This position supports members based in the Community, Group Homes, Assisted Living and Long Term Care settings. This position also ensures facilitation of health care services within a member centric plan of care, under the direction and supervisio

The position is primarily responsible for driving and producing various financial reporting and analytical activities that support Healthcare Management's P&L evaluation on routine basis that lead to key medical cost savings action plans. Key focus areas include developing a detailed understanding of the composition of monthly and year to date revenue and medical cost, in

Resolve process inquiries initiated by hospitals and ancillary providers. May also perform necessary tasks on site. Responsibilities Review and compile monthly, quarterly, and annual reports on quality statistics in order to provide recommendations for process improvement and best practices. Partner with facility employees to identify and bridge financial gaps, i.e.; reso

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

This position is accountable for the development and execution of on going risk adjustment educational communications for the enterprise. The Program Communication Specialist will participate in drafting and producing materials, scheduling, attending and hosting project meetings in support of risk adjustment education and communication. This position will work to broaden

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 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

Data Scientists are responsible for modeling complex business problems, discovering new business insights and finding opportunities through the use of algorithmic, statistical, data mining and visualization techniques. In addition, this role also integrates and prepares large, varied datasets and designs and builds specialized databases and computing environments (data mo

Data analysts are experts with strong understanding of data structures and analysis. They are responsible for ensuring requirements around the accuracy, quality, completeness and timeliness of data are captured and understood. They work hand in hand with Data Modelers, Data Developers, Data Stewards and Business SMEs to ensure the customers data needs are accurately captu

Responsible for the daily management of staff and inventory to ensure delivery of exceptional customer service. Evaluate strengths and weaknesses of staff in order to foster a positive working environment which includes Daily evaluations, coaching and mentoring the business team in order to enhance staff performance levels for quality, production, and attendance while ens

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi