Field-Based RN: Care Coordination & Utilization Mgmt

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive 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 seeks a field-based care coordination professional to assess PCA and MDC services using established guidelines to authorize appropriate care.

The role involves coordinating with members, families, physicians, and hospitals to ensure quality, cost-effective care across the continuum and to educate about SNP when appropriate. NJ RN license is required.

Qualifications

• High School Diploma or GED required; Bachelor preferred or experience in lieu.
• Minimum two years of clinical experience preferred.
• Active NJ RN license required.

Responsibilities

• Assesses patient clinical needs against guidelines to ensure medical appropriateness.
• Evaluates necessity and efficiency of services provided.
• Develops and coordinates services to meet member needs.
• Coordinates with patient, family, physician, hospital and external customers.
• Monitors care activities and outcomes for appropriateness and effectiveness.
• Advocates for members across sites to optimize resource use.
• Completes NJ Choice Home Care assessments for new referrals to MLTSS.
• Supports MLTSS Case Management and Care Management staff as needed.
• Documents thoroughly per standards and policies.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization

Problem solving

Team player

Time management

Written/oral communication

Education

High School Diploma/GED

Bachelor degree preferred

Clinical experience 2+ years preferred

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based care coordination professional to assess PCA and MDC services using established guidelines to authorize appropriate care.

The role involves coordinating with members, families, physicians, and hospitals to ensure quality, cost-effective care across the continuum and to educate about SNP when appropriate. NJ RN license is required.