Care Transformation Specialist at Horizon Blue Cross Blue Shield of New Jersey

About the position The Care Transformation Specialist at Horizon BCBSNJ plays a pivotal role in supporting the organization's Value-Based programs. This position involves collaboration with multidisciplinary frontline clinical personnel, including physicians and nurses, across various care delivery settings to enhance patient-centered care. The specialist will mentor frontline staff, ensuring they maintain regular contact with primary care providers and care team members, and actively participate in multidisciplinary patient-centered team meetings. This role is essential in coordinating the medical neighborhood, which encompasses a wide range of healthcare facilities and services, including hospitals, primary care, specialty care, dialysis facilities, post-acute care, home care, ancillary care, and community resources. The Care Transformation Specialist will work closely with frontline clinical staff, facilitating communication and interaction with multidisciplinary teams both telephonically and in person, to create and manage a comprehensive medical neighborhood. In this key position, the Care Transformation Specialist will be instrumental in transforming medical practices into Patient-Centered Medical Homes and enhancing hospital systems to deliver value-based care. The specialist will be responsible for identifying high-risk, high-need, and potentially high-cost patients, developing interventions to manage these members effectively. This includes creating and facilitating customized Value-Based trainings, such as in-services and WebEx sessions, to promote learning collaboration and drive healthcare delivery transformation focused on population health. The specialist will also coach and mentor Population Care Coordinators, ED Navigators, and other frontline staff to implement best practices in Care Transition Coordination and Population Health Management. Additionally, the Care Transformation Specialist will develop constructive relationships with frontline personnel throughout the medical neighborhood, fostering systems, processes, and initiatives that engage these entities in relevant care management activities. Monitoring practice to ensure coordinated care with all resources, both within the healthcare system and in the community, is a critical aspect of this role. The specialist will facilitate information flow among all members of the care team, lead the implementation of best practices for preventive services, chronic care, and disease management, and ensure timely follow-up primary care visits for patients. By collaborating with practices to create personalized care plans, the specialist will work to improve patient self-management and adherence to these plans, ultimately enhancing the patient experience and member satisfaction. Responsibilities • Identify high risk, high need, and potentially high cost patients and develop interventions to manage them. , • Create and facilitate customized Value-Based trainings for internal and external partners. , • Coach and mentor Population Care Coordinators, ED Navigators, and other frontline staff on best practices. , • Develop relationships with frontline personnel to engage them in care management activities. , • Monitor practice to ensure coordinated care with all resources. , • Facilitate information flow between all members of the care team. , • Lead implementation of best practices for preventive services and chronic care management. , • Ensure timely follow-up primary care visits and appropriate post-transition care. , • Collaborate with practices to create plans of care and improve patient self-management. , • Provide techniques to improve outcomes, such as motivational interviewing and coaching. , • Monitor the delivery of home care, hospice care, and other ancillary services. , • Coordinate necessary referrals and authorizations with Horizon care management areas. Requirements • Experience in healthcare coordination or management, preferably in a value-based care setting. , • Strong understanding of patient-centered care principles and practices. , • Excellent communication and interpersonal skills to work with multidisciplinary teams. , • Ability to develop and facilitate training programs for healthcare staff. , • Experience in coaching and mentoring healthcare professionals. , • Knowledge of population health management and care transition coordination. Nice-to-haves • Familiarity with motivational interviewing techniques. , • Experience with electronic health records (EHR) systems. , • Certification in care coordination or case management. Benefits • Health insurance coverage , • Dental insurance coverage , • 401k retirement savings plan , • Paid time off and holidays , • Professional development opportunities Apply Job!