Field-Based RN Care Navigator

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

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based nurse to assess members and develop individualized plans of care, coordinating with families, physicians and hospitals across the continuum.

Requires an RN license in New Jersey and an associate's or bachelor's degree in nursing, with daily local travel. Strong communication, organization, and documentation skills are essential for delivering high-quality, cost-effective care and ensuring member outcomes.

Qualifications

• Requires an associate or bachelor’s degree (or higher) in nursing and/or accredited diploma nursing school.
• Active Unrestricted NJ RN License Required.
• Proficiency with MS Office and Lotus Notes; knowledge of intranet/internet applications preferred.
• Working knowledge of case/care management principles.
• Prefers knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems.
• Interpersonal & client relationship building skills.
• Organization/Planning/Priority setting.
• Written/Oral communication skills (bi-lingual preferred).

Responsibilities

• Coordinates with patient, family, physician, hospital and other external customers regarding care appropriateness from diagnosis to outcomes.
• Coordinates delivery of high-quality, cost-effective care supported by clinical practice guidelines across the continuum of care.
• Monitors member’s medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for member/family among sites to coordinate resource utilization and evaluation of services.
• Documents accurately and comprehensively based on standards of practice and policies.
• Interacts with multidisciplinary teams via teleconference or in person to ensure continuity of care.
• Understands fiscal accountability and its impact on resource utilization and self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in quality improvement.

Skills

Interpersonal & client relationship

Written/oral communication

Organization/Planning/Priority setting

Bi-lingual preferred

Education

Associate's or Bachelor's degree in nursing

Active NJ RN license

Tools

MS Office (Word/Excel/PowerPoint)

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based nurse to assess members and develop individualized plans of care, coordinating with families, physicians and hospitals across the continuum.

Requires an RN license in New Jersey and an associate's or bachelor's degree in nursing, with daily local travel. Strong communication, organization, and documentation skills are essential for delivering high-quality, cost-effective care and ensuring member outcomes.