Field-Based RN Care Manager

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 79,000 - 106,000; 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 to perform assessments and develop member-centric plans of care. You will evaluate services for medical necessity, coordinate with patients, families and providers, and monitor outcomes across the continuum of care.

The role requires strong clinical judgment and communication skills. Applicants should have a NJ RN license, 2+ years of clinical experience, and the ability to travel daily within New Jersey.

Qualifications

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

Responsibilities

• Assesses member's clinical need against guidelines to ensure services are medically appropriate.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of members' plan of care.
• Coordinates with patient, family, physician, hospital and other external customers regarding care.
• Monitors member's medical care activities and outcomes for appropriateness and effectiveness.

Skills

Analytical

Compassionate

Interpersonal & Client Relationships

Time Management

Written/Oral Communication

Bi-lingual preferred

Team Player

Education

Bachelor degree or relevant experience

High School Diploma/GED required

Tools

MS Office (Word, Excel, PowerPoint)

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based nurse to perform assessments and develop member-centric plans of care. You will evaluate services for medical necessity, coordinate with patients, families and providers, and monitor outcomes across the continuum of care.

The role requires strong clinical judgment and communication skills. Applicants should have a NJ RN license, 2+ years of clinical experience, and the ability to travel daily within New Jersey.