Horizon Blue Cross Blue Shield of New Jersey

Support customer experience improvement initiatives, analyze customer data, and collaborate with cross-functional teams to enhance service quality. | Minimum 5-7 years of experience in management consulting, consumer marketing, or related fields, with 1-2 years in customer experience or process improvement, and strong communication and analytical skills. | Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. This role is responsible for advocating and improving the customer experience within Horizon BCBSNJ. The Customer Experience (CX) Specialist role supports Horizon BCBSNJs priority customer experience improvement initiatives, including touch point redesign and process improvement. Work closely with the Voice of the Customer Team to become a subject matter expert on the CX Dashboards and metrics. Leverage insights from the dashboards to consult with business owners, disseminate results, and build action plans. Assist with planning the bi-weekly agenda of the Horizon BCBSNJ CX Council, including working with cross-functional partners to develop updates to the Council. Work with cross-functional teams that include internal Horizon BCBSNJ business owners and external agency partners to manage a portfolio of CX projects. Includes developing and managing detailed project plans, business cases, and budget. Create journey maps and pain point analyses to identify improvement opportunities. Support Horizon BCBSNJ employee engagement initiatives, including employee training efforts. Advocate for improving the customer experience within Horizon BCBSNJ. The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent. Education: Bachelors degree from an accredited college or university in related field preferred Experience: Minimum 5-7 years of total experience in management consulting, consumer marketing or related field Minimum 1-2 year of experience in a customer experience, market research or process improvement role Skills and Abilities: Strong communication skills, both oral and written Strong analytical skills, including ability to analyze data, draw conclusions, and make recommendations Advanced Microsoft Office skills (Word, Excel, PowerPoint) Abilities: Customer Focus: Keeps customers/members as a top priority when making all business decisions. Develops a strong understanding of customer insights and advocates for solutions that improve the customer experience. Analytical and Strategic Thinking: Applies strategic thinking skills by developing solutions that incorporate both business objectives and consumer insights. Analyzes data and develops actionable conclusions and recommendations. Ownership & Detail Orientation: Takes on ownership and accountability of deliverables and delivers high quality results by developing a deep understanding of insights and cross-functional requirements. Cross-Functional Collaboration: Successfully drives results while operating in a matrix organizational structure and collaborating with multiple stakeholders. Successfully works with internal Horizon BCBSNJ business owners and external agency partners. Project Management: Possesses outstanding and demonstrated project management skills, including managing timelines and deliverables. Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Salary Range: $97,800 - $133,455 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: Comprehensive health benefits (Medical/Dental/Vision) Retirement Plans Generous PTO Incentive Plans Wellness Programs Paid Volunteer Time Off Tuition Reimbursement Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process. About Us We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too. Our Mission We empower our members to achieve their best health. Our Vision We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.

Assess and coordinate appropriate patient care and utilization management ensuring medically appropriate services and transitions across the continuum of care. | Requires active NJ RN license, minimum 2 years clinical experience, knowledge of utilization management and care coordination, and proficiency with Windows and MS Office. | Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 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. Responsibilities: • Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. • Coordinates and assists in implementation of plan for members. • Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care. • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Encourages member participation and compliance in the case/disease management program efforts. • Documents accurately and comprehensively based on the standards of practice and current organization policies. • Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. • Completes other assigned functions as requested by management. Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Education/Experience: • High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires a minimum of two (2) years clinical experience. • Active Unrestricted NJ RN License or active Compact License Required. Utilization Management Only RN's are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards. Requirements may vary based on department's business needs. Knowledge: • Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook) prefers knowledge in the use of intranet and internet applications. • Prefers working knowledge of case/care management principles. • Prefers working knowledge of principles of utilization management. • Prefers basic knowledge of health care contracts and benefit eligibility requirements. • Prefers knowledge of hospital structures and payment systems. Skills and Abilities: • Analytical • Compassion • Interpersonal & Client Relationship Skills • Judgment • Listening • Planning/Priority Setting • Problem Solving • Team Player • Time Management • Written/Oral Communication & Organizational Skills Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Salary Range: $69,500 - $93,030 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: • Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.