SNP Care Manager

Horizon Connect @ Wall BCBSNJ

. Assess members' clinical, functional, and psychosocial needs using established clinical guidelines and care management standards .

Posted 10/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $63,000 - $84,420 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment, care coordination, and case management, ensuring high-quality, member-centered care while adhering to regulatory requirements and best practices. Proficient in utilizing community resources and advocating for members to improve healthcare outcomes.

Highest-signal resume keywords

Clinical AssessmentCare CoordinationCase ManagementHEDIS MeasuresMember Advocacy

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical GuidelinesCare Management StandardsMedical Necessity EvaluationDocumentation StandardsResource ManagementQuality Improvement PrinciplesMedical TerminologyIndividualized Care PlansHealthcare Delivery SystemsManaged Care Concepts

Soft Skills

CommunicationCollaborationProblem-SolvingAdvocacyMonitoring

Certifications & Qualifications

Registered Nurse (RN)Licensed Practical Nurse (LPN)Social Worker (SW)Certified Social Worker (CSW)

Industry Keywords

Home CareDischarge PlanningHealthcare Delivery SystemCommunity ResourcesVulnerable Populations

About the role

Key responsibilities & impact

Assess members' clinical, functional, and psychosocial needs using established clinical guidelines and care management standards
Evaluate the medical necessity, appropriateness, and effectiveness of services provided
Develop, coordinate, and support implementation of individualized, member-centered care plans
Identify healthcare needs, barriers to care, and opportunities to improve outcomes
Coordinate care and services with members, families, physicians, hospitals, community organizations, and other healthcare providers
Ensure seamless care coordination across the continuum of care, from diagnosis through treatment and ongoing support
Advocate for members and families to ensure access to appropriate services, programs, and community resources
Facilitate resource utilization and service coordination across multiple care settings
Provide field-based and telephonic case management services for SNP members
Monitor healthcare services and member outcomes regardless of the site of care
Track member progress and evaluate the effectiveness of interventions and care plans
Identify changes in member conditions and coordinate timely interventions as needed
Maintain accurate, thorough, and timely documentation in accordance with professional standards and organizational policies
Ensure adherence to care management guidelines, regulatory requirements, and quality standards
Support delivery of high-quality, cost-effective care guided by evidence-based clinical practice standards
Promote quality outcomes through ongoing assessment, monitoring, and follow-up

Requirements

What you’ll need

High School Diploma or GED required
Minimum of three (3) years of broad clinical experience
Minimum of three (3) years of experience in home care, discharge planning, case management, or a related healthcare setting
Minimum of three (3) years of experience working within the healthcare delivery system
Active, unrestricted New Jersey license as one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Social Worker (SW), or Certified Social Worker (CSW)
Strong knowledge of case management standards and best practices
Strong understanding of managed care concepts and healthcare delivery systems
Knowledge of HEDIS measures and quality improvement principles
Strong knowledge of medical terminology
Understanding of care coordination, resource management, and member advocacy
Knowledge of community resources and support services available to vulnerable populations
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