Field RN Care Consultant: PCA/MDC & DSNP Assessments

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 seeks a field-based RN to perform assessments for PCA and MDC services using guidelines to ensure appropriate levels of care and services are authorized. The role is based in Hopewell, NJ and is full-time.

Responsibilities include evaluating medical necessity, coordinating care, educating members, and documenting outcomes while collaborating with multidisciplinary teams.

Qualifications

• RN license in New Jersey is required
• Minimum of 2 years clinical experience preferred
• Bachelor's degree preferred or relevant experience in lieu of degree

Responsibilities

• Assess patient’s clinical need 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 services to meet member needs.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Monitor patient’s medical care activities and outcomes for appropriateness and effectiveness.
• Interact and communicate with multidisciplinary teams to ensure continuity of care.

Education

High School Diploma/GED

Bachelor degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based RN to perform assessments for PCA and MDC services using guidelines to ensure appropriate levels of care and services are authorized. The role is based in Hopewell, NJ and is full-time.

Responsibilities include evaluating medical necessity, coordinating care, educating members, and documenting outcomes while collaborating with multidisciplinary teams.