Clinical Care Lead

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

This position is accountable for providing guidance and support to the Dual Special Needs Program (DSNP) Clinical Care Coordinators who perform outreach, and ongoing member contact as well as the clinical care managers who manage the Level 1 members. This position also ensures facilitation of health care services within a member centric plan of care, care gap closure and STARS measures performance under the guidance of the DSNP supervisor.

What You'll Do

• Oversee, develop and coach staff on process, practices and procedures; develop and monitor goals; contribute to annual performance reviews.

• Be a subject matter expert on the DSNP program, and provide staff with instruction and support on it.

• Provides telephonic care management assistance for activities specific to the DSNP case management. Ensure timely member follow up. Interacts and communicates effectively with the member during telephonic contact.

• Perform Clinical Care outreach duties as assigned, carry a caseload / county.

• Assist with implementation and facilitation of services for DSNP members.

• Interacts with the DSNP member/family, physician and healthcare team.

• Utilizes the care plan process to set priorities, plan, organize, and document interventions that are goal directed and member centric.

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

• Run reports to monitor compliance on scheduled services / productivity metrics to ensure timely delivery of services and required follow up in accordance with the model of care.

• Participate in development of business requirements and user acceptance testing for program enhancements.

• Performs other duties as assigned by management.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• Prefers a minimum of two (2) years healthcare industry experience.

• Requires a minimum of one (1) year experience in a managed care setting. Preferably with the elderly frail population.

Knowledge:

• Requires knowledge of the standards of practice for care managers, coordination of services, and delivery of services.

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

Skills and Abilities:

• Requires strong organizational skills.

• Requires strong oral and written communication skills.

• Requires good PC skills, knowledge of working with a Medical Management system for electronic medical records 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.

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:

$63,000 - $84,420

​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.