Field-Based RN Care Manager

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 79,000 - 106,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Field-based Registered Nurse for member assessments and care coordination. You will evaluate clinical needs, develop individualized plans, and coordinate with families, physicians and hospitals to ensure appropriate, cost-effective care across the continuum.

The role requires at least two years of clinical experience and an active NJ RN license; Bachelor degree is preferred.

Qualifications

• Education/Experience: High School Diploma/GED required; Bachelor degree preferred or relevant experience in lieu of degree.
• Clinical experience: minimum of two years.
• Licensure: Active Unrestricted NJ RN License required.
• Knowledge of case/care management and utilization management.
• Familiarity with health care contracts and benefit eligibility.

Responsibilities

• Assess clinical need against guidelines to ensure medically appropriate care.
• Evaluate necessity, appropriateness and efficiency of services.
• Develop and assist in implementation of individualized care plans.
• Coordinate care with patients, families, physicians, hospitals and external stakeholders.
• Monitor care activities and outcomes for appropriateness and effectiveness.
• Advocate for member/family across sites to coordinate resources.
• Ensure accurate documentation per standards and policies.
• Communicate with multidisciplinary teams to maintain continuity of care.
• Contribute to quality improvement and program evaluation.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization

Time management

Written communication

Oral communication

Bi-lingual preferred

Education

Bachelor degree preferred

High School Diploma/GED required

Tools

MS Office (Word/Excel/PowerPoint)

Lotus Notes

Intranet/Internet applications

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Field-based Registered Nurse for member assessments and care coordination. You will evaluate clinical needs, develop individualized plans, and coordinate with families, physicians and hospitals to ensure appropriate, cost-effective care across the continuum.

The role requires at least two years of clinical experience and an active NJ RN license; Bachelor degree is preferred.