Field-Based RN: Care Navigator

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

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to assess members using established guidelines and develop member-centered care plans. The role requires coordinating with patients, families, physicians, and hospitals to ensure medically appropriate care aligned with the plan.

You will document activities per policy, participate in quality improvement, travel daily within the region, and maintain NJ RN licensure.

Qualifications

• Requires an associates or bachelors degree in nursing.
• Minimum of two years clinical nursing experience.
• Active Unrestricted NJ RN License required.

Responsibilities

• Assess members' clinical need against guidelines to ensure appropriate care.
• Evaluate necessity and efficiency of services provided.
• Develop and coordinate individualized plan of care.
• Coordinate with patient, family, physician, hospital and other external customers on appropriateness of care.
• Deliver high quality, cost-effective care aligned with guidelines across the continuum of care.
• Monitor member care activities and outcomes for effectiveness.
• Advocate for members to coordinate resource use.
• Encourage member participation and compliance with the program.
• Document accurately per standards and policies.
• Interact with multidisciplinary teams to ensure continuity of care.
• Understand fiscal accountability and its impact on resource use.
• Contribute to quality improvement programs.
• Complete other assigned functions as requested by management.

Skills

Analytical

Compassionate care

Interpersonal skills

Decision making

Active listening

Organization & planning

Problem solving

Team player

Time management

Communication skills

Education

Associates or Bachelors degree in nursing

Tools

MS Office (Word, Excel, PowerPoint)

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to assess members using established guidelines and develop member-centered care plans. The role requires coordinating with patients, families, physicians, and hospitals to ensure medically appropriate care aligned with the plan.

You will document activities per policy, participate in quality improvement, travel daily within the region, and maintain NJ RN licensure.