Field-Based RN Case Manager: Care Coordination & Outcomes

IntelliResume; Hopewell (NJ); On-site; USD 79,000 - 106,000; 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 to assess members using established guidelines and to develop a member-centric plan of care in collaboration with multidisciplinary teams.

The role requires an active NJ RN license and at least two years of clinical experience; a Bachelor’s degree is preferred or relevant experience in lieu of degree. Full-time, on-site position based in Hopewell, NJ.

Qualifications

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

Responsibilities

• Assess member's clinical needs against established guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of members' individualized plans of care.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Monitor member'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.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and organization policies.
• Interact and communicate with multidisciplinary teams to ensure continuity and efficiency in care management.
• Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Education

High School Diploma/GED

Bachelor degree preferred or relevant experience

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based clinician to assess members using established guidelines and to develop a member-centric plan of care in collaboration with multidisciplinary teams.

The role requires an active NJ RN license and at least two years of clinical experience; a Bachelor’s degree is preferred or relevant experience in lieu of degree. Full-time, on-site position based in Hopewell, NJ.