Field-Based RN Care Manager II

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

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based nurse to assess member needs and develop personalized care plans. You will coordinate with patients, families, physicians, and hospitals to ensure medically appropriate, cost-effective care across the continuum.

This role emphasizes evaluation, documentation, and multidisciplinary collaboration in a dynamic field setting.

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 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 & Client Relationship

Sound Decision Making

Active Listening

Organization/Planning/Priority Setting

Problem Solving/Critical Thinking

Team Player

Time Management

Written/Oral Communication

Education

Bachelor degree preferred or relevant experience in lieu of degree

High School Diploma/GED required

Requires a minimum of two years clinical experience

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based nurse to assess member needs and develop personalized care plans. You will coordinate with patients, families, physicians, and hospitals to ensure medically appropriate, cost-effective care across the continuum.

This role emphasizes evaluation, documentation, and multidisciplinary collaboration in a dynamic field setting.