Field-Based RN Care Manager

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 79,000 - 106,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN Care Manager to assess members, coordinate a plan of care, and advocate for optimal, cost-effective health outcomes.

In this role you will work with members, families, and providers across sites, ensuring appropriate care from diagnosis to outcome, while meeting quality standards and participating in continuous improvement initiatives.

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.
• Active Unrestricted NJ RN License Required.

Responsibilities

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of members- individualized plan of care.
• Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Encourages member participation and compliance in the program.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
• Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Completes other assigned functions as requested by management.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization/Planning

Problem solving

Team player

Time management

Communication skills

Education

Bachelor's degree or relevant experience

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN Care Manager to assess members, coordinate a plan of care, and advocate for optimal, cost-effective health outcomes.

In this role you will work with members, families, and providers across sites, ensuring appropriate care from diagnosis to outcome, while meeting quality standards and participating in continuous improvement initiatives.