Responsible for all workforce functions including budgeting, capacity planning, forecasting, scheduling and real time monitoring. Own and manage creation of leveryday tactical workload forecasting while continuously improving forecasting accuracy taking into consideration new hire classes, meetings, coaching product releases and key disruptions. Provide strategic insight

Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

This position is responsible for performing behavioral health 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 management as assigned by management. Responsibilities Assesses patient's behavioral health clinical need against established guidelines and/

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

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi

The Financial/Accounting Analyst II will be assigned to the Corporate Finance department and will be responsible for Financial, Planning and Analysis and/or accounting responsibilities. The position will be accountable to support the management leadership team on multiples areas of the budgeting, forecasting and accounting areas. This includes working directly with large

Responsible for the daily management of staff and inventory to ensure delivery of exceptional customer service. Evaluate strengths and weaknesses of staff in order to foster a positive working environment which includes Daily evaluations, coaching and mentoring the business team in order to enhance staff performance levels for quality, production, and attendance while ens

Provide guidance and support including reviewing errors, and responding to audit inquiries for internal team members and outsourced staff. Conduct formal observations of business team members, while acting as a technical expert within the business unit. May serve as 'work leader'; mentor and coach new/more junior staff. May participate in on boarding, competency identific

This role is responsible for working collaboratively with members of the Quality & Health Equity Team and HNS to implement, monitor and evaluate Horizon clinical opportunities to develop enterprise and community health initiatives. These initiatives will be aimed at addressing Health Disparities and advancing awareness and education about social determinants of health to

This position is responsible for actively coordinating and promoting Horizon NJ Health's position and services to community organizations, groups and individuals. The position is responsible for enrolling individuals into HNJH products. In addition, this position will interact with the Health Educators for guidance in the areas of promotions and education Responsibilities

This position provides Rating & Underwriting services and support to the Sales team and is responsible for the production of rates for the 51+ markets. This position will support Rating & Underwriting services for Stop Loss products. Develops and issues proposal rates for group size 51+ and experience rated proposals. Develops and issues experience rated renewals for grou

Responsible for managing multiple aspects of the Enterprise medical costs structure including both on system and off system medical costs and directly lead efforts across the Enterprise to provide and present meaningful medical cost trend analysis to drive opportunities and decision making. Collaborate with multiple Commercial and Government Program business partners, inc

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi

The Risk Adjustment Vendor & Performance Analyst is responsible for supporting the management and administration of risk adjustment vendors and performance monitoring of those vendors and the overall risk adjustment department. This includes managing all data transferred to and from Risk Adjustment vendors as well as other external and internal areas related to establishi

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