Field-Based RN Case Manager & Care Coordinator

Horizon Blue Cross Blue Shield of New Jersey; Philadelphia (Philadelphia County); 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 Registered Nurse to assess members, coordinate care, and develop individualized plans. The role involves collaboration with families, physicians, and hospitals to ensure medically appropriate and cost-effective care, with emphasis on documentation and adherence to clinical guidelines.

The position requires an NJ RN license, a minimum of two years of clinical experience, and daily local travel.

Qualifications

• Requires an associates or bachelors degree (or higher) in nursing and/or accredited diploma nursing school.
• Minimum of two years clinical experience.
• Active Unrestricted NJ RN License Required.
• Knowledge of Windows-based environment; MS Office products and Lotus Notes.

Responsibilities

• Assesses member's clinical need against established guidelines to ensure services are medically appropriate.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of member's individualized plan of care.
• Coordinates with patient, family, physician, hospital and other external customers regarding appropriateness of care from diagnosis to outcome.
• Documents accurately and comprehensively based on standards of practice and policies.

Skills

Clinical assessment

Care coordination

Documentation

Interpersonal skills

Bilingual (preferred)

Education

Associate or Bachelor's degree in Nursing

Active NJ RN License

Tools

MS Office

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field‑based Registered Nurse to assess members, coordinate care, and develop individualized plans. The role involves collaboration with families, physicians, and hospitals to ensure medically appropriate and cost-effective care, with emphasis on documentation and adherence to clinical guidelines.

The position requires an NJ RN license, a minimum of two years of clinical experience, and daily local travel.