Jobs at Horizon Blue Cross Blue Shield of New Jersey

Manage the development and negotiation of contracts with healthcare providers, ensuring compliance with standards and enhancing network system efficiencies. Lead a team and collaborate with departments to support healthcare quality and affordability objectives.

Responsible for assessing patients' clinical needs, coordinating care, and ensuring appropriate services while advocating for members in the healthcare continuum.

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.

This role leads a clinical care team, ensuring quality service, compliance, and operational improvement while serving as a medical resource for members and providers.

The Digital Products Reporting Manager will lead and develop reporting and analytics strategies for digital products, present insights to stakeholders, and analyze performance and trends to enhance user experiences and project outcomes.

The Regulatory Compliance Associate ensures compliance with health regulations by analyzing legislative changes, guiding operational compliance, gathering data for reporting, and collaborating with internal divisions.

Manage annual Federal regulatory audits, serve as liaison with CMS, lead a team of analysts, and ensure compliance readiness for audits.

Lead the Payment Integrity Program strategy, managing multiple teams to ensure accurate claims processing and compliance while achieving significant savings for Horizon Blue Cross Blue Shield.

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.

Analyze and translate business needs into product requirements, validate business requirements, document project statuses, and improve benefit coding processes.

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 OON Mandate Arbitration Analyst researches and analyzes complaints and inquiries related to the No Surprises Act, prepares documentation, and assists legal teams with data and case reviews.

The Investigator II role involves investigating claims, detecting fraud, preparing documentation for prosecution, and negotiating settlements. The position requires analytical skills and the ability to manage investigations with limited oversight.

Supervise and execute assigned internal audits: develop scope and work programs, perform testing and analysis, document control issues, prepare reports, manage staff, liaise with management, and track issues to closure while promoting audit best practices.

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

Lead and execute IT audit programs, document results, guide staff auditors, and provide recommendations on internal controls.

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 RN I will perform clinical assessments, coordinate care plans, advocate for members, monitor services, and ensure quality care delivery.