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Dir, Speciality Health Disparity Initiatives

Horizon Blue Cross Blue Shield
Newark, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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Summary
About the job:
Connecticut or Delaware Job Summary: This role is responsible for working collaboratively with members of the Quality & Health Equity Team and HNS to implement, monitor and evaluate Horizon clinical opportunities to develop enterprise and community health initiatives. These initiatives will be aimed at addressing Health Disparities and advancing awareness and education about social determinants of health to develop innovative strategies to advance health equity in health care access and delivery for our members. The...
Location:
Newark, NJ
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Licensed Master Social Worker
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Community Health Representative-Northern New Jersey

Horizon Blue Cross Blue Shield
Hopewell, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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About the job:
Connecticut or Delaware Job Summary: This position is responsible for actively coordinating and promoting Horizon NJ Health's position and services to community organizations, groups and individuals. The position is responsible for enrolling individuals into HNJH products. In addition, this position will interact with the Health Educators for guidance in the areas of promotions and education Responsibilities - Responsible for educating and enrolling potential members into HNJH products. - Serves as a representative at...
Location:
Hopewell, NJ
Job Type:
Full-Time
Permanent
Occupation:
Community Health Workers
Career Level / Education:
Bachelor's degree
Salary:
Entry Level Jobs (less than $30K)
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Mgr, Medical Cost Mgmt

Horizon Blue Cross Blue Shield
Newark, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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Summary
About the job:
Connecticut or Delaware Job Summary: Responsible for managing multiple aspects of the Enterprise medical costs structure including both on-system and off-system medical costs and directly lead efforts across the Enterprise to provide and present meaningful medical cost trend analysis to drive opportunities and decision making. Collaborate with multiple Commercial and Government Program business partners, including both clinical and financial, to drive the Medical Cost Trend Committee with the goal of identifying...
Location:
Newark, NJ
Job Type:
Full-Time
Permanent
Occupation:
Managers, All Other
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Team Leader I - Service Operations Contact Center

Blue Cross Blue Shield of Michigan
Detroit, MI
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External Description Str : The Service Operations Team Leader I will be ...
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About the job:
responsible for the supervision of team members in the Contact Center Operation. Supervision may occur onsite or remotely, therefore it is important for the Team Leader I to have the ability to perform the essential duties and responsibilities both onsite and remotely. Provide real time coaching, motivation, mentoring, development, recognition, and appraisal for assigned team member group. This activity includes, but is not limited to: Planning, prioritizing, and assigning work, team member face to face and virtual...
Location:
Detroit, MI
Job Type:
Full-Time
Permanent
Occupation:
First-Line Supervisors of Office and Administrative Support Workers
Career Level / Education:
High school diploma or equivalent
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

RN I-NICU-Medicaid-Care, Case and Disease Management

Horizon Blue Cross Blue Shield
Hopewell, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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Summary
About the job:
Connecticut or Delaware Job Summary: This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: - Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. - Evaluates the...
Location:
Hopewell, NJ
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

RN I

Horizon Blue Cross Blue Shield
Newark, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
Details
Summary
About the job:
Connecticut or Delaware Job Summary: This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: - Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. - Evaluates the...
Location:
Newark, NJ
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medicare Advantage Clinical Care Manager

Blue Cross Blue Shield of Massachusetts
Hingham, MA
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Ready to help us transform healthcare? Bring your true colors to blue. The ...
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Summary
About the job:
Role The Clinical Care Manger is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care. The Clinical Care Manger will engage members in...
Location:
Hingham, MA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Licensed Independent Clinical Social Worker
Licensed Clinical Social Worker
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Coordinator, Managed Care I

Blue Cross Blue Shield Of South Carolina
Lexington, SC
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Summary Reviews and evaluates medical or behavioral eligibility regarding ...
Details
Summary
About the job:
benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description 50% Performs...
Location:
Lexington, SC
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Certified Registered Nurse
Licensed Master Social Worker
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Manager, Medical Bill Review, Hybrid Remote in Lansing, MI or Remote opportunity

Blue Cross Blue Shield of Michigan
Located in Ohio
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Hybrid Remote in Lansing, MI. Will consider candidates for a Remote ...
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Summary
About the job:
opportunity. Must be able to accommodate EST office hours and reside within the U.S. Provide leadership and direction to a claims operational team that focuses on Workers' Compensation Medical Bill Review. Act as a primary, independent, visionary and proactive authority; providing in-depth analysis of claims operational areas including statistical, industrial and regulatory perspectives. Provide operational consistency and integrity to claims. Serve as a technical expert with regard to department operations....
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
First-Line Supervisors of Office and Administrative Support Workers
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Driver's License
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Supervisor, Medical Only, Hybrid Remote in Lansing, MI

Blue Cross Blue Shield of Michigan
Located in Ohio
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This position is located in Lansing, MI. Hybrid Remote Effectively ...
Details
Summary
About the job:
supervises the day-to-day work and team performance of the Non-Exempt Medical Only Claim Specialists to ensure the goals and customer service expectations are met. Acts as a direct supervisor for non-exempt claim professionals handling assigned claims. Responsible to supervise all aspects of this team and work with other departments as it relates to process, workflows, and continuous improvement opportunities which may cross departments. Identify ways to continuously improve claim process and workflows. Objectively evaluate...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
First-Line Supervisors of Office and Administrative Support Workers
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information
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