This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

This position is responsible for resolution of escalated issues and audits of daily operations of the HR Shared Services Center. This position serves as back up to HR Shared Services Manager and will maintain confidential employee records on the Workday Human Resources Information System (HRIS). This position will provide HRMS support, customer service to employees, as we

This position is an extended member of the departments leadership team and is responsible for the supervision and the execution of assigned audits and strategic initiatives. These responsibilities include ensuring the appropriateness of the scope, quality and execution of testing and reporting, and the identification as well as tracking of issues to closure. Responsibilit

This is a senior level manager position within the Actuarial department. Supporting Level Funded product and additionally supporting Stop Loss products, including all areas of actuarial work pricing, reserving, forecasting, etc Lead internal meetings providing transparency and understanding of the actuarial analyses and results Collect and analyze data to use for actuaria

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

This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. Responsibilities Supports the pharmacy formulary management program, medication therapy management program

This position is responsible for helping to identify, secure, and maintain community based housing for MLTSS/SNP/Medicaid Members and for developing, articulating, and implementing a broader housing strategy within the Contractor to expand housing availability/options. The Housing Specialist(s) shall act as the Contractors central housing expert(s)/resource(s), providing

The Mgr, Health & Network Solutions (HNS) Implementation is responsible for leading implementation projects across multiple functional teams while ensuring delivery excellence, driving key business initiatives and solutions across the project while developing standard methodologies to improve efficiencies This individual will manage a team and serve as the primary point o

This position is responsible for managing, monitoring, supporting, and participating in the development/enhancements of distributive system management platforms. Job Description Resolve issues through level 3 in server, operating systems or other software under the control of the Distributed Systems management team Provide guidance to junior infrastructure analysts and fo

Under limited direction, this position is accountable for contributing to the efficiency of departmental operations through the performance of various administrative functions. This position reports to an officer of the company and may provide leadership to the departmental administrative team. Responsibilities Handle and disperse appropriate matters (i.e. email, memos, i

This position ensures excellent customer service by responding in a timely, accurate and thorough manner to general requests. In addition this position is accountable for assisting in the preparation and analysis of data and for maintenance and initial reconciliation of accounts. Coordinate with Service and Billing to address customer inquiries related to Account Receivab

Responsible for all workforce functions including budgeting, capacity planning, forecasting, scheduling and real time monitoring. Own and manage creation of leveryday tactical workload forecasting while continuously improving forecasting accuracy taking into consideration new hire classes, meetings, coaching product releases and key disruptions. Provide strategic insight

Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

The Manager of Clinical Analytics is a managerial position requiring excellent leadership, communication, and data analytics technical skills. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to support clinical performance analytics, development, and reporting that deliver actionable clinic

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi