Jobs: Horizon Blue Cross Blue Shield of New Jersey

  • RNI, Personal Care Medical/Medical Daycare/DSNP-Union County

    Found in: Lensa US P 2 C2 - 5 days ago


    Newark, United States Horizon Blue Cross Blue Shield Full time

    **Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware** Job Summary: This field based position is responsible for performing assessments for PCA and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized. **Responsibilities:** * Assesses...

  • CLINICAL CARE ASSOCIATE

    Found in: Careerbuilder One Red US C2 - 4 hours ago


    Hopewell, NJ 08525, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This position is accountable for assisting and extending support to the MLTSS RN/MLTSS Care Specialist working in the field. This position supports members based in the Community, Group Homes, Assisted Living and Long Term Care settings. This position...

  • Medicare Member Service Representative

    Found in: beBee jobs US - 5 days ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Medicare Member Service Representative Remote work availableFull Time$20.51 / hour ($40,000 / year)Compensation: Starting at $20.51/hour ($40,000/year) during12-week training (9 weeks classroom training, 3 weeks lab)Eligible for increase after completion of specified milestones as outlined in Medicare Member Service progression modelOpportunities for...

  • Medicare Member Service Representative

    Found in: Lensa US P 2 C2 - 7 days ago


    Hingham, United States Blue Cross Blue Shield of Massachusetts Full time

    Ready to help us transform healthcare? Bring your true colors to blue. Medicare Member Service Representative Remote work available Full Time $20.51 / hour ($40,000 / year) Compensation: Starting at $20.51/hour ($40,000/year) during12-week training (9 weeks classroom training, 3 weeks lab) Eligible for increase after completion of specified milestones as...

  • DISAB/WC NURSE CM I

    Found in: Careerbuilder One Red US C2 - 2 hours ago


    Wall Township, NJ, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:Provides case management services for PIP and/or workers compensation cases with lost time, complex medical care, and/or high medical utilization. Ensures appropriateness and cost effectiveness of care, and optimal outcomes. Coordinates cases with...

  • CLINICAL RISK ADJUSTMENT MANAGEMENT RN

    Found in: Careerbuilder One Red US C2 - 5 hours ago


    Newark, NJ 07101, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This position will perform care management duties specifically targeting high-risk members within Medicare Advantage/Commercial risk adjusted populations to enhance the deployment of risk adjustment tactics. This position will work closely with the...

  • CLINICAL RISK ADJUSTMENT MANAGEMENT RN

    Found in: Careerbuilder One Red US C2 - 3 hours ago


    Newark, NJ 07101, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This position will perform care management duties specifically targeting high-risk members within Medicare Advantage/Commercial risk adjusted populations to enhance the deployment of risk adjustment tactics. This position will work closely with the...


  • Quincy, United States Blue Cross Full time

    **Customer Service Representative | Member Service Division | May 2022** Location Quincy, Massachusetts, 02171 Full time Job Id R04803 Category Customer Service Posted Date: 02/28/2022 JOB DESCRIPTION **** Member Service Representative**$1,000 Sign-on Bonus *** Remote work available (MA candidates preferred) Full Time $ 20.00 / hour ($39,000 / year) As...

  • PROFESSIONAL RESIDENT-1

    Found in: Careerbuilder One Red US C2 - 9 hours ago


    Newark, NJ 07101, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This is a one-year, structured post-graduate education and training program in a Medicaid managed care HMO. The goal of the position is to provide advanced knowledge and skills regarding drug therapy and pharmaceutical services in a managed care...

  • PROFESSIONAL RESIDENT-2

    Found in: Careerbuilder One Red US C2 - 6 hours ago


    , NJ, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This is a one-year, structured post-graduate education and training program in a Medicaid managed care HMO. The goal of the position is to provide advanced knowledge and skills regarding drug therapy and pharmaceutical services in a managed care...

  • Process Control Processor

    Found in: beBee jobs US - 3 days ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    This position is open to the Resident persona only- You must be able to be in office daily. Position Summary:Process Control is the front-line of the Operations Division providing support to countless internal business areas. The primary responsibility is to prepare paper claims and/or documents for scanning in a timely and accurate manner on behalf of our...

  • Mental Health Clinical Care Manager- Medicare Advantage

    Found in: beBee jobs US - 3 days ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Continually assess and evaluate member and family needs utilizing strong communication skills, critical thinking, clinical knowledge, data, and tools.Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.Interpret and apply case management criteria, processes, policies,...

  • RN I

    Found in: Careerbuilder One Red US C2 - 4 hours ago


    Wall Township, NJ, USA, United States Blue Cross and Blue Shield Association Full time

    Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob 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...

  • Clinical Utilization Reviewer- Medicare Advantage

    Found in: beBee jobs US - 11 hours ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex healthcare needs, authorizing medically necessary services at the right level of care to promote optimal health.This position is self-directed and works independently and collaboratively to facilitate care using clinical skills, principles of...

  • Claims IC Appeals Nurse Coder

    Found in: beBee jobs US - 10 hours ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Job Profile:Job Code: CRBusiness Title: Appeals Nurse Coder ReviewerReports To: Patricia Corsini RN, BSNThe RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This position requires strong clinical...

  • FLORIDA BLUE CENTER ONSITE RN

    Found in: Careerbuilder One Red US C2 - 8 hours ago


    Sarasota, FL 34236, USA, United States Blue Cross and Blue Shield Association Full time

    Get to know usFlorida Blue, a GuideWell Company, has been providing insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million healthcare members across the state.We are looking for exceptional people who will bring our mission to life and succeed by...

  • Senior Data Engineer Lead

    Found in: Lensa US P 2 C2 - 1 week ago


    Eagan, United States Blue Cross Blue Shield of Minnesota Full time

    About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. How Is This Role Important to Our Work? This position is responsible for...

  • Case Manager

    Found in: beBee jobs US - 3 days ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    The RoleThe 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...

  • RN Utilization Management Reviewer

    Found in: beBee jobs US - 3 days ago


    Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Job Profile: RN Utilization Management Job Code: HCM420Business Title: Clinical Utilization ReviewerReports To: Manager, Utilization ManagementThe RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex healthcare needs, authorizing medically necessary services at the right level of care to promote optimal...

  • Senior Data Engineer Lead

    Found in: Lensa US P 2 C2 - 6 days ago


    St Paul, United States Blue Cross Blue Shield of Minnesota Full time

    About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us. How Is This Role Important to Our Work? This position is responsible for providing...