Care Manager I, Specialty Programs

Horizon Connect @ Wall BCBSNJ

. Perform care coordination duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care for specialty populations.

Posted 9/15/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $70,500 - $94,395 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in care coordination, implementing high-quality, cost-effective care, and advocating for members across healthcare teams. Proficient in assessing clinical needs, utilizing managed care principles, and ensuring compliance with practice standards.

Highest-signal resume keywords

Registered Nurse LicenseCase Management StandardsManaged Care PrinciplesSpecialty Population KnowledgeOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Care CoordinationClinical AssessmentUtilization MonitoringQuality ImprovementGoal-Directed Interventions

Soft Skills

Oral CommunicationWritten CommunicationProblem SolvingConflict Resolution

Tools & Technologies

Microsoft OfficeExcelAccessWord

Certifications & Qualifications

Registered Nurse License

Industry Keywords

Care TransitionsResource UtilizationSpecial Needs PopulationHealthcare TeamsNew Jersey State License

About the role

Key responsibilities & impact

Perform care coordination duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care for specialty populations.
Implement interventions to ensure efficient utilization of benefits.
Assess members’ clinical needs against established guidelines and standards.
Implement high-quality, cost-effective care based on customized population models and clinical practice guidelines.
Partner with members/families, physicians, and healthcare teams to meet member needs.
Advocate for members across sites and coordinate resource utilization.
Set priorities, plan, organize, and implement goal-directed interventions supporting self-care outcomes and transition to independent status.
Ensure care for mandated non-compliant members through utilization monitoring.
Document accurately and comprehensively according to practice standards and organization policies.
Evaluate care, solve problems, analyze variances, and participate in quality improvement.
Monitor care activities and outcomes for appropriateness and effectiveness.
Consult internal stakeholders on complex cases and escalate to internal physician resources as appropriate.
Complete other assigned functions as requested by management.

Requirements

What you’ll need

Requires a license as an RN, or Bachelor degree in social work, health or behavioral science.
Requires a minimum of three (3) years’ experience serving members with special needs.
Graduate level degree in Social Work or Health and Behavioral Science preferred.
Requires strong knowledge of the standards of practice for case managers.
Requires strong knowledge of managed care principles.
Requires strong knowledge of specialty population, as applicable.
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 a car with valid New Jersey State License and Insurance for certain positions.
Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Benefits

Comp & perks

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