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 10/22/2026full-timeRemote • United StatesMid-LevelSenior💰 $70,500 - $94,395 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination, clinical assessment, and resource utilization for specialty populations, ensuring compliance with established guidelines and standards. Proficient in problem-solving, documentation, and quality improvement processes while effectively communicating with members, families, and healthcare teams.

Highest-signal resume keywords

Licensed RNBachelor Degree In Social WorkThree Years Experience With Special NeedsKnowledge Of Managed Care PrinciplesStrong Organizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care CoordinationClinical AssessmentUtilization MonitoringQuality ImprovementDocumentation Standards

Soft Skills

Oral CommunicationWritten CommunicationProblem SolvingConflict Resolution

Tools & Technologies

Microsoft OfficeExcelAccessWord

Certifications & Qualifications

RN License

Industry Keywords

Specialty PopulationStandards Of PracticeManaged CareCare Transitions

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.
Assess members’ clinical needs against established guidelines and/or 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 and coordinate resource utilization.
Set priorities, plan, organize, and implement goal-directed interventions supporting self-care and transition to independent status.
Ensure care for mandated non-compliant members through utilization monitoring.
Document accurately and comprehensively according to standards of practice and organizational policies.
Evaluate care, solve problems, analyze variances, and participate in quality improvement.
Monitor care activities and outcomes for appropriateness and effectiveness across sites of service and networks.
Consult internal stakeholders on complex cases and escalate appropriately to internal physician resources.
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.
Graduate level degree in Social Work or Health and Behavioral Science preferred.
Requires a minimum of three (3) years’ experience serving members with special needs.
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.
Horizon BCBSNJ 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