HorizonBlue Cross Blue Shield New Jersey Jobs & Careers

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

Jobs 1 to 20 of 50
HorizonBlue Cross Blue Shield New Jersey Trenton, NJ, 08601
Job Summary: This position is responsible for the efficient functioning of the appeals resolution correspondence unit. This position is responsible for basic appeals resolutions and administrative appeals for Mercy Health Plan of NJ, (MHPNJ) and with supervision, ensuring that timeliness guidelines and accuracy standards are met. Responsibilities: Input and update basic demographic customer and cl...
HorizonBlue Cross Blue Shield 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. Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Responsibilities: Assesses patient's clinical need against establis...
HorizonBlue Cross Blue Shield 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. 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 level of care a...
HorizonBlue Cross Blue Shield New Jersey Trenton, NJ, 08601
Job Summary This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Major Responsibilities Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data fr...
HorizonBlue Cross Blue Shield 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. 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 level of care...
HorizonBlue Cross Blue Shield 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. Performs duties and types of care management as assigned by management. Major Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of...
HorizonBlue Cross Blue Shield 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. Performs duties and types of care management as assigned by management. Major Responsibility Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of ca...
HorizonBlue Cross Blue Shield New Jersey Newark, NJ, 07101
Job Summary: This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators. Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients...
HorizonBlue Cross Blue Shield New Jersey Trenton, NJ, 08601
Job Summary This position is responsible for providing support to the Social Case Management Consultants with outreach and ongoing case management activities of non-complex cases Responsibilities Completes a preliminary assessment, evaluates members needs, and refers complex cases to Care Specialist. Provides on going care management services to non-complex cases and maintains accurate documentati...
HorizonBlue Cross Blue Shield 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 contractu...
HorizonBlue Cross Blue Shield 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. 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 level of care...
HorizonBlue Cross Blue Shield 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. 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 level of care...
HorizonBlue Cross Blue Shield 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. Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Responsibilities: Assesses patient's clinical need against establis...
HorizonBlue Cross Blue Shield 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. Performs duties and types of care management as assigned by management. Major Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of...
HorizonBlue Cross Blue Shield New Jersey Trenton, NJ, 08601
Job Summary Responsible for managing network communications, problem resolution, project initiative implementation, training and education to promote cost effective quality practice patterns and to ensure network compliance with regulatory/internal policies and procedures. For Horizon Casualty Services, may also manage the HCS arbitrations and appeals process with strategic focus on trending, root...
HorizonBlue Cross Blue Shield New Jersey Wall, NJ, 07719
RN Field Educator/ Sales Specialist Job Summary: This position is accountable for providing an array of special services to new and existing members to maximize the potential for new sales, retention and expansion of business relationships. Candidates will actively coordinate and promote Horizon's position and services to community organizations, and individuals. Responsibilities: Initiates call b...
HorizonBlue Cross Blue Shield New Jersey Newark, NJ, 07101
Job Summary: 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 position. Responsibilities...
HorizonBlue Cross Blue Shield New Jersey Newark, NJ, 07101
Job Summary: This full time, dedicated position is accountable for supporting MCR (Medical Cost Reduction) initiatives through feasibility study, implementation and post-installation monitoring. These projects include delegated vendor programs, Burgess and other out-of-network pricing methodologies and recovery opportunities. This position provides analytical support and coordinates the successful...
HorizonBlue Cross Blue Shield New Jersey Wall, NJ, 07719
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-...
HorizonBlue Cross Blue Shield New Jersey Ewing Township, NJ, 08618
Job Overview: This position is responsible for managing the relationships between Horizon NJ Health (HNJH) and Managed Long Term Support and Services (MLTSS) providers and vendors to maintain communication related to HNJH issues. Major Responsibilities: Manages relationships with MLTSS providers and vendors by addressing concerns and ensuring that provider/ vendor contracts are adhered to and fulf...
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