Care Manager

Horizon Connect @ Wall BCBSNJ

. Assess patients' clinical needs against established guidelines and/or standards to ensure services are medically appropriate.

Posted 10/9/2026full-timeRemote • United StatesMid-LevelSenior💰 $63,000 - $84,420 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including the development and coordination of individualized care plans, while ensuring compliance with established clinical guidelines and standards. Proficient in advocating for patients and families, utilizing strong communication and organizational skills to navigate the healthcare delivery system effectively.

Highest-signal resume keywords

Case Management ExperienceClinical Practice GuidelinesManaged Care PrinciplesMedical Terminology KnowledgeNJ SW/RN/LPN License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare CoordinationResource UtilizationDocumentation StandardsProblem SolvingConflict ResolutionPresentation Skills

Soft Skills

Organizational SkillsOral CommunicationWritten Communication

Tools & Technologies

Microsoft OfficeExcelAccessWord

Certifications & Qualifications

Active Unrestricted NJ SW/RN/LPN LicenseCSW

Industry Keywords

Health Care Delivery SystemHome CareDischarge PlanningElderly Frail PopulationHEDIS

About the role

Key responsibilities & impact

Assess patients' clinical needs against established guidelines and/or standards to ensure services are medically appropriate.
Evaluate the necessity, appropriateness, and efficiency of services provided.
Develop, coordinate, and assist in implementing members' individualized plans of care.
Coordinate with patients, families, physicians, hospitals, and other external customers regarding appropriateness of care from diagnosis to outcome.
Coordinate high-quality, cost-effective care across the continuum using clinical practice guidelines.
Monitor patients' medical care activities and outcomes across all sites of service.
Advocate for members and families across various sites to coordinate resource utilization and evaluate services.
Document accurately and comprehensively according to standards of practice and organizational policies.
Provide field-based and/or telephonic case management activities for the Dual Special Needs program.

Requirements

What you’ll need

High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Requires a minimum of three (3) years' broad clinical experience.
Requires a minimum of three (3) years' experience in home care, discharge planning, or case management. Preferably with the elderly frail population.
Requires a minimum of three (3) years' experience in the health care delivery system/industry.
Active Unrestricted NJ SW/RN/LPN License or CSW Required.
Requires strong knowledge of the standards of practice for case managers.
Requires strong knowledge of managed care principles and concepts including Health Plan Effectiveness Data and Information Sheet (HEDIS).
Required knowledge of medical terminology.
Requires strong organizational skills.
Requires strong oral and written communication skills.
Requires good PC skills 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.
Requires a car with valid New Jersey State License and Insurance.

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement