Field-Based RN Care Coordinator - SNP/MLTSS

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; 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 is seeking a field-based nurse role to perform assessments for PCA and MDC services, ensuring medically appropriate care and authorized services.

You will evaluate necessity and efficiency of care, coordinate services across the continuum, and advocate for members with various care providers. Requires NJ RN license and travel within the region.

Qualifications

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• A minimum of two (2) years clinical experience is preferred.

Responsibilities

• Assesses patient's clinical need against established guidelines to ensure services are medically appropriate.
• Evaluates the necessity, appropriateness and efficiency of service provided.
• Develops, coordinates and assists in implementation of services to meet member needs.
• Coordinates with patient, family, physician, hospital and external customers on care appropriateness from diagnosis to outcome.
• Coordinates delivery of high quality, cost-effective care supported by plan guidelines across the continuum of care.
• Monitors patient’s medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among sites to coordinate resource utilization and evaluation of services.
• Refers members to MLTSS when appropriate.
• Educates members on SNP availability when appropriate.
• Documents accurately based on standards and policies.
• Interacts with multidisciplinary teams to ensure continuity of care.
• Understands fiscal accountability and its impact on resource utilization.
• Completes NJ Choice Home Care Assessments for new referrals to MLTSS.
• Assists with MLTSS Case Management to cover for FMLA or maintain caseloads.
• Supports MLTSS Care Management staff with annual assessments and post-hospital visits.
• Evaluates care by problem solving and quality improvement participation.
• Completes other duties as assigned by management.
• Performs duties as assigned by management.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization/Planning

Problem solving

Team player

Time management

Written/Oral comms

Education

High School Diploma/GED

Bachelor degree preferred or experience in lieu

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based nurse role to perform assessments for PCA and MDC services, ensuring medically appropriate care and authorized services.

You will evaluate necessity and efficiency of care, coordinate services across the continuum, and advocate for members with various care providers. Requires NJ RN license and travel within the region.