Jobs at Horizon Blue Cross Blue Shield of New Jersey

The Paralegal III provides litigation and transactional support, conducts legal research, prepares documents, and collaborates with attorneys and departments.

The UM Appeals Analyst prepares and presents appeals cases, manages communications, mentors junior staff, and ensures compliance with UM processes.

The Data Financial Reporting Analyst manages data supporting revenue and accounts receivable, performs complex financial analysis, and prepares reports for management. They lead junior analysts, ensure accurate month-end activities, support Medicaid revenue reporting, and engage in special projects while maintaining relationships with internal stakeholders.

The RN II Case Manager assesses patient needs, coordinates care, monitors medical activities, mentors staff, and ensures that care is appropriate and efficient throughout the continuum of care.

This RN position assesses patient clinical needs, coordinates care plans, partners with multidisciplinary teams, and ensures the appropriateness of care and resource utilization.

The RN II position entails assessing patient needs, coordinating care, mentoring staff, and advocating for members through effective communication and adherence to clinical guidelines.

Supervise and execute audits, ensuring quality and effectiveness of internal controls, while managing staff and providing strategic recommendations to management.

Lead job architecture initiatives and compensation strategies, provide market pricing oversight, mentor junior staff, and support compensation projects across divisions.

The National Programs Analyst coordinates Association initiatives, ensures compliance, resolves issues impacting claims, and collaborates with IT for systemic solutions.

The BH Clinician assesses behavioral health needs, coordinates care plans, advocates for patients, and documents interactions to ensure quality care and compliance.

The CPC Investigator conducts coding reviews, audits medical records, analyzes claims for fraud, and manages investigative activities related to healthcare operations.

The Pharmacy Specialist I is responsible for processing prior authorization requests, engaging with healthcare professionals, and maintaining compliance with regulations, while ensuring quality service metrics are met.

The Quality Management Specialist supports project planning and implementation, analyzes data for quality improvements, manages budgets, and enhances healthcare services through collaboration and performance measurement.

The RN I position involves assessing patient care needs, coordinating care services, monitoring quality, advocating for members, and documenting healthcare activities. Requires interaction with multidisciplinary teams and understanding of utilization management.

The role involves conducting data analysis for process improvement, leading initiatives, mentoring staff, and developing business cases using ROI models to enhance efficiency and reduce costs.

The Senior HR Business Partner serves as a strategic advisor to executives, shaping people strategies to enhance organizational effectiveness, culture, and employee experience while managing complex HR functions.

The role involves creating technology strategies for applications, managing a large tech team, overseeing project lifecycles, vendor relationships, and budget management to ensure quality and service levels in IT deliveries.

The Account Manager IV is responsible for retaining client accounts and selling additional services within the Labor market. This role includes managing renewals, maintaining relationships with stakeholders, resolving issues, and providing strategic support across labor groups.

Responsible for managing clinical pharmacy programs, formulary management, medication therapy management, and assisting medical teams with drug information services and prior authorizations.

The Strategic Initiatives Analyst supports enterprise initiatives through research, data collection, analysis, and effective presentations. The role requires both independent and collaborative work and the ability to synthesize complex information into actionable recommendations.