Oncology Case Manager RN II: Mentor & Care Navigator

Horizon Blue Cross Blue Shield NJ; New Jersey; Remote; 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 an experienced registered nurse to assess and coordinate care transitions, mentor staff, and engage in payer-related projects. You will apply established guidelines to ensure safe, effective patient pathways and support members through the continuum of care.

The role emphasizes collaboration with physicians, hospitals, and families, with mentoring responsibilities and opportunities to contribute to committees and process improvements at

Qualifications

• High School Diploma or GED required.
• Bachelor’s degree preferred or relevant experience in lieu of degree.
• Minimum of two (2) years clinical experience.
• Minimum of two (2) years’ experience with health care payer experience.
• Active NJ RN License or Compact License is required.
• CCM certification preferred.

Responsibilities

• Assess patient's clinical needs against guidelines to ensure appropriate care.
• Evaluate necessity, appropriateness, and efficiency of medical services.
• Coordinate and assist in implementing care plans for members.
• Monitor and coordinate services outside of the network.
• Negotiate fees for services as appropriate.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Advocate for members and families throughout their healthcare journey.
• Document accurately based on standards of practice.
• Interact with multidisciplinary teams to ensure continuity of care.
• Serve as a mentor/trainer to new RNs and staff.

Skills

Clinical nursing

Mentoring

Care coordination

Collaboration

Payer experience

Education

High School Diploma/GED

Bachelor’s degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced registered nurse to assess and coordinate care transitions, mentor staff, and engage in payer-related projects. You will apply established guidelines to ensure safe, effective patient pathways and support members through the continuum of care.

The role emphasizes collaboration with physicians, hospitals, and families, with mentoring responsibilities and opportunities to contribute to committees and process improvements at