The Care Transformation Specialist will support Horizons Value Based programs by working with multidisciplinary frontline clinical personnel, including physicians and nurses, within multiple care delivery settings for the entire spectrum of patient population. This person will mentor the frontline staff on promoting patient centered care, on maintaining frequent contact w

This position is responsible for the pick up and delivery of mail and supplies between Horizon buildings and U.S. Post Office. This position will also be responsible for commuter and passenger van services. Drives the van between all Horizon locations and picks up/delivers mail and supplies. Monitors the workflow of mail receivables throughout the unit. Loads and unloads

The Certified Professional Coder Investigator II is responsible for performing highly complex healthcare fraud investigations including but not limited to, complex surgical operations, inpatient hospital coding including diagnostic related grouping (DRG), and anesthesia cases. The incumbent is responsible for coding oversight of medical records to ensure the appropriate C

This position is responsible for developing programs that enhance and support the Corporate Social Responsibility team's vision, strategic planning, financial management and funding operations that support the overall objectives of Horizon Blue Cross Blue Shield of New Jersey. This positon will oversee the Horizon Cares programs, Horizon's internal platform of benefits th

Lead and drive the innovative transformation of Horizon's payment landscape to enable better affordability and quality of care while also contributing to improved member and provider experience. This team will be focused on strategic work aimed at better aligning financial incentives and key network partnerships with behaviors that result in high provider network performa

The Senior Analyst, Strategic Initiatives, reports to the Manager, Strategic Initiatives, and will be a key contributor across a wide range of strategic projects. The senior analyst is responsible for managing project workstreams, conducting qualitative and quantitative data collection, performing analyses, and developing content to support strategic initiatives. The incu

This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa

The Regulatory Compliance Associate is responsible for the identification and communication of new, revised, and pending federal and state laws, regulations, and standards relevant to a Horizon Lines of Business (LOB). This position administers and coordinates the functions associated with compliance and regulatory guidelines related to each market and will develop and ma

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

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Responsibilities Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs. Evaluate

This Specialist will support the Provider Account Manager with establishing and fostering collaborative, trusting provider relationships to drive improved provider satisfaction and performance. This position will help drive execution of key support deliverables, be a data SME, and ensure project work plans are executed resulting with high quality deliverables. Responsible

Under general supervision, responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. This is an intermediate level position performing basic assignments, and may require guidance. Responsibilities Evaluate, write, and present utilization and cost containment reports. Determine or agree

The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis deliverables (i.e. tables, visual

This position is accountable for the development and execution of on going risk adjustment educational communications for the enterprise. The Program Communication Specialist will participate in drafting and producing materials, scheduling, attending and hosting project meetings in support of risk adjustment education and communication. This position will work to broaden

This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa