Field-Based RN Care Navigator – PCA/MDC/SNP

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

Benefits offered by this job

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 clinician in Hopewell, NJ to assess medical necessity and coordinate services for PCA and MDC programs. The role requires nursing licensure, clinical experience, and strong collaboration with patients, families, physicians, and care teams.

This full-time position offers a competitive salary and comprehensive benefits as you advocate for members and ensure appropriate, efficient care across settings.

Qualifications

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

Responsibilities

• Assess patient’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 services to meet member needs.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Monitor patient’s medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members/families among various sites to coordinate resource utilization and evaluation of services.
• Refer members to MLTSS when appropriate.
• Educate members on the availability of SNP if appropriate.
• Document accurately and comprehensively based on standards of practice and current organization policies.
• Interact and communicate with multidisciplinary teams to strive for continuity and efficiency in care management.

Skills

Clinical assessment

Care coordination

Documentation

Interdisciplinary collaboration

Advocacy

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based clinician in Hopewell, NJ to assess medical necessity and coordinate services for PCA and MDC programs. The role requires nursing licensure, clinical experience, and strong collaboration with patients, families, physicians, and care teams.

This full-time position offers a competitive salary and comprehensive benefits as you advocate for members and ensure appropriate, efficient care across settings.