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

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

The Mgr, Regulatory Compliance is responsible for the daily oversight and management of compliance activities across the assigned Horizon Line of Business (LOB). This position ensures that the Enterprise operates in compliance with applicable federal and state laws and regulations. The Manager will advise and influence business leaders across functional areas and implemen

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

This position supports the Clinical Operations functions and acts as a liaison between members, physicians, delegates, operational business members and member service coordinators. Responsible for providing leadership and guidance to non clinical team and handle escalated issues/problems. Responsibilities Performs review of service requests for completeness of information

This position is responsible for performing LPN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care under the direction/supervision of an RN. Performs duties and types of care management as assigned by management. Responsibilities Performs the following job responsibilities under the direc

This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management. Responsibilities Supports the pharmacy formulary management program, medication therapy management program

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situatio

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

This position is responsible for leading execution and implementation activities for specific projects within HNS. This role will facilitate the development, coordination, communication, and accomplishment of short and long term business and clinical initiatives. The incumbent will act as a liaison between the department and other constituencies, will communicate and lead

This position reports to the Manager, Product Management & Innovation and will assist in the design, development and enhancement of new and existing health plan products across the Commercial medical market segments for Horizon BCBSNJ that support the enterprise corporate strategic goals. Supports the development of short and long term strategic product plans in support o

This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high ri

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

This position is responsible for resolution of escalated issues and audits of daily operations of the HR Shared Services Center. This position serves as back up to HR Shared Services Manager and will maintain confidential employee records on the Workday Human Resources Information System (HRIS). This position will provide HRMS support, customer service to employees, as we

This position is an extended member of the departments leadership team and is responsible for the supervision and the execution of assigned audits and strategic initiatives. These responsibilities include ensuring the appropriateness of the scope, quality and execution of testing and reporting, and the identification as well as tracking of issues to closure. Responsibilit