Care Transformation Specialist

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

The Care Transformation Specialist will support Horizons Value-Based programs by working with multidisciplinary frontline clinical personnel, including physicians and nurses, within multiple care delivery settings for the entire spectrum of patient population. This person will mentor the frontline staff on promoting patient-centered care, on maintaining frequent contact with primary care providers and care team members and on effectively participating in multidisciplinary patient-centered team meetings. Care Transformation Specialist will be responsible for coordinating the medical neighborhood and working with frontline clinical staff, interacting and communicating with multidisciplinary teams either telephonically and/or in person along the continuum of care on creation and management of medical neighborhood including but not limited to hospitals, primary care, specialty care, dialysis facilities, post acute care, home care, ancillary care, community resources and Horizon programs. This is a key role in the transformation of the medical practice into a Patient-Centered Medical Home and transforming hospital systems to perform value.

1 .Works with internal and external stakeholders to help identify high risk, high need, and potentially high cost patients as well as the development of interventions to manage those members.

2. Creates and facilitates customized Value-Based trainings, including in-services, WebExs, and other educational materials 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.

3. Coaching and mentors Population Care Coordinators, ED Navigators and other frontline staff to implement best practices around Care Transition Coordination and Population Health Management.

4. Develops constructive relationships with frontline personnel throughout a medical neighborhood in order to develop systems, processes and initiatives to engage these entities in relevant care management activities with each Horizon insured member to ensure that all necessary transition needs are met.

5. Monitors practice to ensure care is coordinated with all resources, both within a system and in the community. Facilitates practice information flow between all members of the care team.

6. Leads practice implementation of processes for best practices for preventive services, chronic care and disease management including utilization of tools to prioritize patient needs. Monitors practice to make sure follow-up primary care visits are obtained in a timely manner and that visits include all appropriate post transition care.

7. Collaborates with practice on working with the patient to create plans of care and work to improve patient self-management and adherence to the plan of care.

8. Provides techniques to practice to achieve improved outcomes such as motivational interviewing and coaching, group visits, advanced scheduling and the incorporation of behavioral health tools and resources into practice.

9. Works with practice to improve the patient experience and member satisfaction through changes in the service delivery model.

10. Monitors the practice to assure that appropriate home care, hospice care, and other ancillary services (DME, infusion services etc.) are in place and are being delivered as directed by the care team with communication and coordination in place.

11. Coordinates with practice of necessary referrals and authorizations with Horizon care management areas and tracking follow-up visits and communication with appropriate specialists and patients including regarding testing.

12. Educates provider staff on Value Based models of care, Horizons implementation of these models and use of Horizon resources (such as case management and mental health partner) to improve member outcomes. Educates providers on the use of data and tools to track performance of clinical outcomes and development of new clinical interventions, based on data, to improve those outcomes.

13. Serves as a consulting resource for the frontline clinical staff on enrolling members in Horizon care programs and facilitating communication between those programs and the patients medical team.

Education/Experience:
- Requires Bachelor's degree from an accredited college or university, preferably in Nursing, Healthcare Management or related field.
- Requires five (5) years of direct patient care experience in primary care office, acute inpatient, rehabilitation, sub-acute, skilled facility, or home care required
- Prefer familiarity with community resources and social service resources to assist patients with social needs
- Prefer previous experience as a Population Care Coordinator, discharge coordinator or navigator
- Prefer direct experience with motivational interviewing or behavioral coaching

Additional licensing, certifications, registrations:
- Requires a NJ Registered Nurse License or a SW license
- Requires an active NJ Drivers License
- Prefer Certified Case Management (CCM) certification.

Knowledge
- Requires working knowledge of principles of utilization management, case/care management and benefit eligibility requirements
- Requires knowledge of hospital structures and payment systems

Skills
- Must have excellent and professional verbal and written communication skills
- Requires ability to provide meaningful education to patient, caregivers and other healthcare personnel in a wide variety of settings
- Strong ability to work independently as well as in a team environment
- 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 working with cross-functional teams to achieve improvements and taking initiative to finding solutions to difficult or sensitive problems, including asking probing questions in a respectful manner
- Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities and tasks, deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required.
- Ability to work with basic healthcare data to manage a population of members
- Must be proficient in use of personal computers and supporting software and use of Windows environment including Microsoft office products( Word, Excel, PowerPoint and Outlook) and must be able to use technology to educate and mentor

Travel (If Applicable):
Extensive within the state of New Jersey

This role may also be used in other areas of HCM to partner with other value based programs.

Salary Range:

$76,800 - $102,795

​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

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.