Field-Based RN Care Manager — Patient Advocate

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based nurse to perform PCA and MDC service assessments, ensuring appropriate care and services are authorized. The role requires evaluating care necessity, coordinating with families, physicians, and facilities, and documenting outcomes following plan guidelines.

The ideal candidate holds an active NJ RN license, at least two years of clinical experience, and is willing to travel daily within New Jersey to support members and

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 guidelines to ensure medically appropriate services.
• Evaluates necessity, appropriateness and efficiency of provided services.
• Develops and coordinates services to meet member needs.
• Coordinates with patient, family, physician, hospital and other external customers.
• Monitors care activities and outcomes for appropriateness and effectiveness.
• Educates members on SNP availability where appropriate.
• Documents accurately per standards and policies.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization

Team player

Time management

Bi-lingual (preferred)

Education

Bachelor's degree preferred

High School Diploma/GED

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based nurse to perform PCA and MDC service assessments, ensuring appropriate care and services are authorized. The role requires evaluating care necessity, coordinating with families, physicians, and facilities, and documenting outcomes following plan guidelines.

The ideal candidate holds an active NJ RN license, at least two years of clinical experience, and is willing to travel daily within New Jersey to support members and