Oncology Care Navigator - RN II

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); Teletrabalho; USD 90 000 - 120 000; Tempo integral

Resumo da oferta

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN for utilization management and care coordination. The role focuses on evaluating care, planning transitions, and mentoring staff to ensure high-quality, cost-effective services across the continuum of care.

Two years of clinical experience and payer experience are preferred, with an active NJ RN license and a bachelor’s degree preferred.

Qualificações

• Active NJ RN license required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of two years clinical experience.
• Minimum of two years’ health care payer experience.

Responsabilidades

• Assesses patient care needs against guidelines to ensure appropriate inpatient level of care.
• Evaluates necessity and efficiency of medical services.
• Coordinates and implements plans for members.
• Monitors services outside the network and negotiates fees as appropriate.
• Advocates for members among sites to coordinate resource utilization.
• Mentors/trains new staff and serves as SME for projects and committees.

Conhecimentos

RN duties

Case management

Payer experience

Mentoring

Advocacy

Formação académica

Bachelor degree preferred

Active NJ RN License

Two years clinical experience

Two years payer experience

Descrição da oferta de emprego

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN for utilization management and care coordination. The role focuses on evaluating care, planning transitions, and mentoring staff to ensure high-quality, cost-effective services across the continuum of care.

Two years of clinical experience and payer experience are preferred, with an active NJ RN license and a bachelor’s degree preferred.