Care Specialist III, Field

Horizon Connect @ Wall BCBSNJ

. Assess and case-manage members to facilitate health care services.

Posted 10/21/2026full-timeUnited StatesMid-LevelSenior💰 $70,500 - $94,395 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including assessment, coordination of care, and advocacy for members. Proficient in utilizing clinical practice guidelines and managed care principles to deliver high-quality, cost-effective services.

Highest-signal resume keywords

Bachelor Degree In Health Related FieldThree Years Experience In Case ManagementActive Unrestricted NJ SW LicenseStrong Knowledge Of Managed Care PrinciplesStrong Oral And Written Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementAssessmentResource UtilizationClinical Practice GuidelinesCaseload ManagementProblem SolvingConflict ResolutionPresentation SkillsHuman Services PrinciplesCare Management Process

Soft Skills

Organizational SkillsInterpersonal SkillsAdvocacyCollaborationGoal-Directed Interventions

Tools & Technologies

Microsoft Office ApplicationsExcelAccessWord

Certifications & Qualifications

Active Unrestricted NJ SW License

Industry Keywords

Managed Care IndustryHome CareDischarge PlanningElderly Frail PopulationQuality Improvement Activities

About the role

Key responsibilities & impact

Assess and case-manage members to facilitate health care services.
Assist with implementation and facilitation of services to members in the program.
Collaborate with members/families, physicians, and internal and external healthcare team members.
Coordinate high-quality, cost-effective care based on member needs, program models, and clinical practice guidelines.
Advocate for members/families across various sites to coordinate resource utilization and evaluate services.
Set priorities, plan, organize, and implement goal-directed interventions using the care management process.
Encourage member participation and compliance with case management program efforts.
Document accurately and comprehensively according to practice standards and organization policies.
Communicate with members through face-to-face and telephonic contact.
Evaluate care, solve problems, analyze variances, and participate in quality improvement activities.
Provide field-based and/or telephonic case management activities.
Perform duties as assigned by management.

Requirements

What you’ll need

Bachelor degree required in a health related or behavioral science field.
Requires a minimum of three (3) to four (4) 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 two (2) years' experience in the managed care industry.
Active Unrestricted NJ SW License Preferred. Candidates with a restricted license will not be considered.
Requires local travel and possible on call work specific to the managed long term support and services case management program.
Requires strong knowledge of the standards of practice for care managers.
Requires ability to interview and assess Members.
Requires caseload management and casework practices.
Requires human services principles for determining eligibility for benefits and services for their members.
Requires the ability to effectively solve problems and locate community resources.
Requires the needs and service delivery system for all populations in the Care Manager’s caseload.
Prefers strong knowledge of managed care principles and concepts.
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.
Daily local travel is required.

Benefits

Comp & perks

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