Field-Based RN Care Manager: Patient-Centric Care

IntelliResume; Hopewell, Mobile (NJ, AL); On-site; USD 79,000 - 106,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based Nurse role to assess members and develop care plans. The position emphasizes care coordination, documentation, and cross-site advocacy to ensure medically appropriate and effective services.

Requires an NJ RN license, a high school diploma or GED, and at least two years of clinical experience; a Bachelor's degree is preferred or equivalent experience. The role is based in Hopewell, NJ with full-time schedule.

Qualifications

• High School Diploma/GED required.
• Bachelor's degree preferred or relevant experience in lieu of degree.
• Minimum of two (2) years clinical experience required.
• Active Unrestricted NJ RN License required.

Responsibilities

• Assess member's clinical need against established guidelines to ensure medically appropriate services.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of members' individualized plans of care.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Monitor member's medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and organization policies.
• Interact and communicate with multidisciplinary teams to ensure continuity and efficiency in care management.
• Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Skills

Clinical assessment

Care coordination

Documentation

Multidisciplinary teamwork

Quality improvement

Education

High School Diploma/GED

Bachelor's degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based Nurse role to assess members and develop care plans. The position emphasizes care coordination, documentation, and cross-site advocacy to ensure medically appropriate and effective services.

Requires an NJ RN license, a high school diploma or GED, and at least two years of clinical experience; a Bachelor's degree is preferred or equivalent experience. The role is based in Hopewell, NJ with full-time schedule.