Field-Based RN Case Manager (NJ) - Care Coordination

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 perform assessments of members using established guidelines and develop member-centric care plans. The role involves coordinating with patients, families, physicians, and hospitals to ensure appropriate and cost-effective care across the continuum.

Requires an active NJ RN license and at least two years of clinical experience. Daily local travel with a need for a valid NJ driver's license is expected.

Qualifications

• High School Diploma or GED required; Bachelor degree preferred or applicable experience in lieu of degree.
• Minimum of two (2) years clinical experience.

Responsibilities

• Assesses member's clinical need against guidelines to ensure medically appropriate services.
• 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 external customers regarding care appropriateness from diagnosis to outcome.
• Coordinates the delivery of high quality, cost-effective care aligned with practice guidelines.
• Monitors member's medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for the member/family across sites to coordinate resource utilization and evaluation of services.
• Encourages member participation and compliance in the program.
• Documents accurately and comprehensively per standards and policies.
• Interacts with multidisciplinary teams telephonically and/or in person for continuity of care.
• Understands fiscal accountability and impact on resource utilization.
• Evaluates care by problem solving and participates in quality improvement.
• Completes other assigned functions as requested by management.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization/Planning

Problem solving

Team player

Time management

Written/Verbal communication

Education

High School Diploma/GED

Bachelor's degree preferred or relevant experience

Tools

MS Office

Lotus Notes

Intranet/Internet applications

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to perform assessments of members using established guidelines and develop member-centric care plans. The role involves coordinating with patients, families, physicians, and hospitals to ensure appropriate and cost-effective care across the continuum.

Requires an active NJ RN license and at least two years of clinical experience. Daily local travel with a need for a valid NJ driver's license is expected.