Field-Based DSNP Care Manager | Care Coordinator

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced field-based nurse case manager to support Dual Special Needs members. You will assess clinical needs, develop and coordinate an individualized plan of care, and collaborate with patients, families, physicians and hospitals to ensure appropriate, cost-effective care.

Responsibilities include monitoring outcomes, documenting per policy, coordinating resources, and providing field-based or telephonic case management.

Qualifications

• High school diploma or GED required; bachelor preferred or equivalent experience.
• Minimum three years clinical experience in home care, discharge planning, or case management.
• Active NJ license or CSW required; solid knowledge of care standards.

Responsibilities

• Assesses patients' clinical needs against guidelines to ensure medically appropriate services.
• Evaluates necessity and efficiency of services provided.
• Develops, coordinates and assists in implementation of individualized care plans.
• Coordinates with patient, family, physician, hospital and external partners on care from diagnosis to outcome.
• Delivers high-quality, cost-effective care following plan guidelines across the continuum of care.
• Monitors care activities and outcomes for appropriateness and effectiveness.
• Advocates for members among sites to coordinate resources and services.
• Documents accurately per standards and organizational policies.
• Provides field-based and/or telephonic case management for Dual Special Needs.

Skills

Field-based work

Communication skills

MS Office

Problem solving

Education

Bachelor's degree

High School Diploma/GED

Active NJ SW/RN/LPN License or CSW

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced field-based nurse case manager to support Dual Special Needs members. You will assess clinical needs, develop and coordinate an individualized plan of care, and collaborate with patients, families, physicians and hospitals to ensure appropriate, cost-effective care.

Responsibilities include monitoring outcomes, documenting per policy, coordinating resources, and providing field-based or telephonic case management.