Field-Based RN Case Manager – Care Coordination

Horizon Blue Cross Blue Shield; Passaic (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 an experienced field-based RN Case Manager to coordinate care for members in New Jersey. You will assess clinical needs, develop member-centered care plans, and collaborate with providers across the continuum.

Join a mission-driven organization that values compassionate, data-driven care, strong communication, and teamwork, with opportunities for professional growth and competitive benefits.

Qualifications

• High School Diploma/GED required; Bachelor’s degree preferred or relevant experience.
• Active Unrestricted NJ RN License required.
• Minimum of two years clinical experience.
• Proficiency with Windows and MS Office; Lotus Notes experience desirable.
• Knowledge of case/care management and utilization management principles.

Responsibilities

• Assesses member's clinical need against guidelines to ensure medically appropriate care.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of member-centered plan of care.
• Coordinates with patient, family, physician, hospital and other external customers.
• Coordinates the delivery of high quality, cost-effective care with clinical guidelines across the continuum.
• Monitors member's medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate utilization of resources.
• Encourages member participation and compliance in the program.
• Documents accurately per standards and policies.
• Interacts with multidisciplinary teams via phone and in person to ensure continuity of care.

Skills

Analytical

Compassionate

Interpersonal & Client Relationship

Sound Decision Making

Active Listening

Organization/Planning/Priority Setting

Problem Solving/Critical Thinking

Team Player

Time Management

Written/Oral Communication Skills

Bi-lingual preferred

Education

High School Diploma/GED

Bachelor's degree preferred

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced field-based RN Case Manager to coordinate care for members in New Jersey. You will assess clinical needs, develop member-centered care plans, and collaborate with providers across the continuum.

Join a mission-driven organization that values compassionate, data-driven care, strong communication, and teamwork, with opportunities for professional growth and competitive benefits.