This position is responsible for receiving verbal and written request for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad hoc reporting, correspondence and special projects. Must maintain pe

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 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 management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and com

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

The Medical Director is a medical spokesperson for Horizon Blue Cross Blue Shield with the provider network across NJ. The Medical Director will be accountable for providing leadership, direction and daily support for their assigned region of NJ and assigned providers; the scope of activities include, but are not limited to, utilization management, care management, diseas

This position contributes to Quality Improvement efforts through the research, analysis, design, programming, implementation and coordination of accurate and timely reporting. The incumbent will partner with multiple customers across the Enterprise to provide complex resolutions to analytics/data problems and will provide reporting/analytic deliverables (i.e. tables, grap