Iliana Delgado

Care Specialist I - DCP&P (Department of Child Protection and Permanency)

Horizon NJ Health

02.2012 - Current

Manage Care Coordinator II- CBCM (Community Base Case Management)
Complete a preliminary health assessments, evaluate members’ needs, and refer complex cases to Care Manager for Case Management
Provide ongoing care management services and maintain accurate documentation of members outreach
Prepare, document and route cases in appropriate system for clinical review
Assist with on-boarding and training of newly hired Managed Care Coordinators I
Assist with authorization of services as necessary
Develop and maintain a network of current community programs and resources
Refer members to community programs in order to empower members, remove barriers and provide access to quality medical care, adherence to medical advice and services
Represent Horizon BCBS-NJ in contacts with providers, members, and hospital personnel
Assist members with finding providers, PCA Agencies, resolving problems and answer questions regarding anything from how to obtain services to how to file an appeal
Upon completion of inquiry investigation/resolution, initiate call back or correspondence to physicians/members to coordinate/verify case completion
Review medical, dental, vision and pharmacy claims and address gaps in care
Assist members making appointments with their PCP, specialist and transportation
Work with DME provides to help member obtain needed medical equipment
Process PCP, demographic changes and new ID cards as requested by member or case manager
Provide member education regarding preventative medical care, transportation services, managed care processes and access issues, as well as available Horizon-BCBSNJ programs.

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