HorizonBlue Cross Blue Shield New Jersey Jobs & Careers

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15 HorizonBlue Cross Blue Shield New Jersey jobs found on Monster.

Jobs 1 to 15 of 15
Horizon Blue Cross Blue Shield of New Jersey - PROD Ewing, NJ, 08560
Job Overview: This position is accountable for establishing partnerships with hospital(s) through proactive account management activities at key levels of the hospital(s) (e.g. Chief Executive Officer/Chief Financial Officer/Chief Medical Officer/Chief Information Systems Officer). This position will have overall responsibility for the coordination of all administrative and service activities tha...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: Responsible for the quality review of claims to enhance the clinical, network, and case management services offered by Horizon Casualty Services, Inc. (HCS). These audits review daily business practice compliance to regulatory compliance relative to contractual, internal and URAC standards. Responsibilities: Performs audits on claims and correspondence to determine the accuracy and...
Horizon Blue Cross Blue Shield of New Jersey Trenton, NJ, 08601
Job Summary: 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. Responsibilities: Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Assesses patient's clinical need against est...
Horizon Blue Cross Blue Shield of New Jersey - PROD Ewing, NJ, 08560
Job Overview: This position is responsible for assisting in the daily support and administration of reimbursement system(s) for participating physicians, acute care hospitals and ancillary institutional providers. Incumbent is accountable for review, analysis and implementing processing systems enhancements, and recommendations of business solutions. Also assists with quantitative and qualitative...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Divisional Manager will provide strategic, financial and operational support in key areas to the newly created Office of the Vice President, Administration and Chief Security Officer. Responsibilities will include: Partner with divisional business teams regarding divisional, executive and board reporting Coordinate all compliance related matters of the business functions in the division Pri...
Horizon Blue Cross Blue Shield of NJ Newark, NJ, 07101
Job Summary: This position will be part of an innovative program changing the model for health care delivery. The Partner Outcomes and Relationships Specialist is a member of Horizon Healthcare Innovations (HHI) Clinical Innovation team, and supports the Manager, Partner Contracting, Outcomes and Relationships for the on-going assessment and support of practices participating in the programs. The...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Business Process Improvement Implementation Manager II reports to the Manager of Enterprise Business Process Improvement and is responsible for conducting data collection and analysis to support process improvement projects to reduce cost and complexity across the enterprise. As a Business Process Improvement Manager, the incumbent will draft and review project deliverables and analysis such a...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
Job Summary: Perform analytical studies related to Risk Adjustment. Assist in implementing the RA under ACA. Coordinate with Medicare and Medicaid risk adjustment programs. Responsibilities: The primary responsibility is to perform risk adjustment analytical studies that involve manipulations of large amounts of data; apply advanced programming techniques to streamline the analysis. Conduct gap...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Director, Security Operations is responsible for the development of short and long term strategies for Horizon’s Security Operations group, as well as to align with Horizon's enterprise strategy and to ensure optimization of Horizon’s infrastructure, resources and capabilities. This role translates strategies into tactical functions and develops Security system architecture to ensure they can ...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Enterprise Information Security Architect will apply a combination of business process analysis and technical knowledge to develop enterprise security architectural deliverables that identify and describe the relationships among functions, data, applications and technology at various levels at Horizon-BCBSNJ. The person will perform individual assignments and lead project teams composed of Bus...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: This position will be part of an innovative program changing the model for health care delivery. The Partner Outcomes and Relationships Specialist is a member of Horizon Healthcare Innovations (HHI) Clinical Innovation team, and supports the Manager, Partner Contracting, Outcomes and Relationships for the on-going assessment and support of practices participating in the programs. The...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The L&D Training Coordinator is responsible for supporting and coordinating the design, rollout and administration of Enterprise Learning & Development education programs for management and individual contributor professional development. The candidate’s job responsibilities will include: Run, distribute and administer class rosters for HR sponsored courses, including, but not limited to Manageme...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
This position establishes and oversees the strategic direction of the records and information management program for the Company. This position will (1) ensure and facilitate compliance with legal and regulatory obligations, (2) promote the efficient use of Company resources devoted to managing records and information, and (3) oversee management of the Company’s records in all formats and througho...
Horizon Blue Cross Blue Shield of New Jersey - PROD Trenton, NJ, 08601
Job Overview: In a call center environment, this position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projec...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Director of Government Programs - Compliance and Medicare Compliance Officer is accountable for oversight of the Medicare Compliance Program and officially manages the interface with the Centers for Medicare and Medicaid Services (CMS), the federal regulatory agency over the Medicare Advantage (MA) and Medicare Prescription Drug (Part D) line of business. This position oversees the implementat...

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