Viewing 1 - 10 of 28 jobs
Job 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...
Job Summary: This position is accountable for providing day-to-day guidance, support and medical leadership for utilization management activities and decisions. This position is responsible for supporting the Chief Medical Director in all...
Job Summary: The Marketing Retention Specialist provides analytical support to the Manager of Retention on member disenrollment data (including drivers) for key membership demographics. Activities will include data collection, trending and...
Job Summary: This position is responsible for developing, maintaining and managing the pricing functions to support Horizons' initiatives in the areas of financial modeling, analysis forecasting and development of provider reimbursement.
an analyst position in the Informatics department to turn Horizon's data into business knowledge. Provide meaningful analytic output that meet the needs of internal and external customers in the areas of Actuarial, Account Reporting,...
Resolves issues and improves operational performance on a cross-functional/departmental basis. This is an intermediate level position and may require guidance. Responsibilities: Investigate service related issues to identify root cause of...
other purchases via eligible business vendors according to Horizons policies and processes Gather information and prepare reports as requested Obtain information, status reports, or answers on various business matters, inquiries or...
Job Summary: This position is accountable for the management of high risk level cases identified through the care management program to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
Job Summary: This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy...
is a three time recipient of the New Jersey Horizon Blue Cross Blue Shield patient care quality award. Licensed for 501 beds with a medical staff of more than 600, RBMC provides medical-surgical, maternity, pediatric, diagnostic imaging,...