Field-Based RN Care Manager & Utilization Specialist

Horizon Blue Cross Blue Shield; New Jersey; On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Wellness programs

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to perform assessments for PCA and MDC services, ensuring medically appropriate care and alignment with benefit structures. You will coordinate with patients, families, physicians, hospitals and other stakeholders to optimize care across the continuum, while participating in quality improvement and cost-effective care initiatives.

The role requires an active NJ RN license, at least two years of clinical experience, and

Qualifications

• High School Diploma or GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.

Responsibilities

• Assesses patient’s clinical need against established guidelines to ensure medically appropriate services.
• Evaluates necessity, appropriateness and efficiency of provided services.
• Develops and coordinates services to meet member needs and advocates for care across sites.
• Completes NJ Choice Home Care assessments for new referrals to MLTSS and assists with MLTSS caseloads.
• Provides support to MLTSS Care Management Staff and participates in quality improvement efforts.

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to perform assessments for PCA and MDC services, ensuring medically appropriate care and alignment with benefit structures. You will coordinate with patients, families, physicians, hospitals and other stakeholders to optimize care across the continuum, while participating in quality improvement and cost-effective care initiatives.

The role requires an active NJ RN license, at least two years of clinical experience, and