Care Coordinator I

: Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position supports the workers- compensation claim operations and utilization management functions and acts as a liaison between claimants, providers, external claim representatives, clients and attorneys

• Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
• Handles initial screening for precertification requests from physicians/claimants via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
• Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently.
• Coordinates the treatment plans proposed by providers, in accordance with established HCS protocols.
• Upon collection of clinical and non clinical information CC can authorize medical treatment and associated diagnostic testing based upon scripts or algorithms used for pre-review screening.
• Acts as liaison with client to identify issues and problems relating to care management and claim processing and forwards concerns to appropriate parties, when necessary.
• Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment.
• Perform other relevant tasks as assigned by management.

Education/Experience:

• Minimum high school diploma or GED
• Prefers a bachelors degree.
• Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.

Knowledge:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
• Requires knowledge of medical terminology.
• Prefers knowledge of understanding of case management, philosophy and process. Skills and Abilities Strong typing, data entry and numeric keypad skills necessary. Must be comfortable using a calculator for simple math calculations.
• Analytical and Problem Solving Skills Customer Focus Interpersonal and Client Relationship Skills Communication (both verbal and written) and Organizational Skills Decision Making Flexibility/Adaptability.

Salary Range: $53,500 - $71,610 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.