HorizonBlue Cross Blue Shield New Jersey Jobs & Careers

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

Jobs 1 to 20 of 28
Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ, 08560
The Program Director: Government Programs has overall responsibility for planning, directing, and coordinating activities pertaining to the startup and ongoing operations of this Horizon business division, which encompasses Medicare, Medicare Supplemental, and Medicaid (including MLTSS) lines of business. Much of the initial work will be on planning and coordinating the strategic vision and implem...
Horizon Blue Cross Blue Shield of New Jersey - PROD Trenton, NJ, 08601
Job Overview: This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. Major Responsibilities: Supports the pharmacy formulary management program, medication therapy management program, ...
Horizon Blue Cross Blue Shield of New Jersey - PROD Ewing Township, NJ, 08618
Supervisor, HCM (Network Data Management) This position sits within the Network Data Management group and is responsible for overseeing the review and maintenance of provider data – data related to provider contracting, provider credentialing etc. This position is accountable for the daily management, training and development of four direct reports, overseeing department work assignments, activit...
Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ, 08628
The Divisional Information Leader III identifies changes and trends in computer and systems technology and interprets their meaning to senior management. The candidate participates in overall business planning; bringing a current knowledge and future vision of technology and systems as related to the organization’s competitive position. Additionally, the role determines long term organization wide...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Overview: This position is accountable for the acquisition of new business (Medicare Advantage Employer Group), conservation of existing accounts and selling additional product lines where appropriate for the SHBP Local, FEP, Small Group Broker, Medicare, Midsize, and Dental markets. Major Responsibilities: Acquires new business (Medicare Advantage Employer Group). Manages contract renewal...
Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ, 08560
Job Summary: The position is responsible for preparation of standard and adhoc medical cost reports. The position performs and/or supports analysis of medical cost and utilization trends, medical cost drivers and outliers, and medical cost reduction opportunities. The position works with various departments to fulfill data and reporting needs for medical cost management. The position is responsib...
Horizon Blue Cross Blue Shield of New Jersey - PROD Trenton, NJ, 08601
Job Overview: This position is responsible for receiving verbal and written request 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 projects. Must maintain performance i...
Horizon Blue Cross Blue Shield of New Jersey Trenton, NJ, 08601
Job Summary: This position will be a-part of the Special Investigation Unit (SIU). Responsible for identifying and detecting insurance fraud by analyzing complex healthcare data. Working with marginal oversight, the incumbent is responsible for performing complex research, analysis, and reporting of network utilization, cost containment and key operational information. Responsibilities: Mine da...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Overview: This position will work independently to collaborate with sales to coordinate, drive, and write quality Request for Proposal (RFP) and Request for Information (RFI) submissions along with executing on multiple deadlines. Major Responsibilities: Coordinates and drives the RFP and RFI process including proofreading of all materials. Attends and prepares for strategy meetings, raisi...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Infrastructure Analyst V - Messaging is responsible for monitoring, supporting, and participating in the development/enhancements of distributive system management platforms. Resolve issues through level 3 in server, operating systems or other software under the control of the Distributed Systems management team Provide guidance to junior infrastructure analysts and follows guidance and dire...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Summary: This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9-...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Summary: Under supervision of an Assistant General Counsel the Associate General Counsel is responsible for providing legal advice to management with regard to supporting Horizon Healthcare Management division of the company. The Associate General Counsel develops and maintains internal relationships and provides coordination with outside counsel when necessary. The Associate General Counsel ...
Horizon Blue Cross Blue Shield of New Jersey Ewing Township, NJ, 08618
Data Reporting Analyst Job Overview: Responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. Working with marginal oversight, the incumbent is responsible for performing complex research, analysis, and reporting of network utilization, cost containment and key operational information. This is a senior level ...
Horizon Blue Cross Blue Shield of New Jersey Trenton, NJ, 08601
Job Summary: The position is responsible for leading a specific clinical care team in a hands-on manner to provide exceptional service to the customer and contain medial claims cost. This is accomplished through active involvement and leading of the day-to-day operations of a clinical care team and ensuring staff is consistent with Horizon's policies and procedures and are compliant with contract...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: Provide forecasting, reporting, and scheduling support for the Service Division on a yearly, monthly, and daily basis. Responsibilities: Analyze data for the purpose of predicting future call volumes and provide recommendations for staffing requirements accordingly for both internal and outsourced staff. Utilize the call center databases (Workforce Management System, Telephone Swi...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Manager of Enterprise Business Process Improvement reports to the Director of Enterprise Business Process Improvement and is responsible for guiding process improvement projects to reduce cost and complexity across the enterprise. As a manager of business process improvement (BPI) projects, the incumbent will define deliverables, structure project workplans and provide thought leadership to so...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Business Process Improvement Implementation Manager reports to the Manager of Enterprise Business Process Improvement and is responsible for conducting data collection and analyses 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 analyses such as v...
Horizon Blue Cross Blue Shield of New Jersey - PROD 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, Solution Development, for the on-going assessment and support of pilot practices. The primary role of Partner Outcomes and Relationship...
Horizon Blue Cross Blue Shield of New Jersey - PROD Trenton, NJ, 08601
Job Summary: This entry level position is accountable analytical and investigative activities (external and internal) related to claims, enrollment, accounting and other operations to detect, receive and review suspected fraud and to complete cases with all information and analysis for resolution as the manager and prior approved guidelines may direct. Responsibilities: Prepares and documents f...
Horizon Blue Cross Blue Shield of New Jersey Trenton, NJ, 08601
Job Summary: This position is responsible for the development, contracting, training and ongoing management of a statewide, comprehensive and accessible network of Managed Long-Term Support and Service (MLTSS) providers. MLTSS span a broad range of up to 30 different provider types including facility-based services such as Skilled Nursing Facilities (custodial and rehabilitative), Assisted Living...

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