Pediatric Case Manager RN — Care Coordination

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 71,000 - 94,000; 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 registered nurse to perform care management duties and plan transitions along the continuum of care. You will assess patient needs and coordinate with the care team to optimize outcomes and resource use.

The role involves collaborating with patients, families, physicians, and hospitals, monitoring care across settings, and advocating for the member to ensure cost-effective, high-quality care aligned with guidelines.

Qualifications

• Associates or Bachelors degree in nursing or health related field or accredited diploma nursing school.
• Active Unrestricted NJ RN License.
• Minimum of two years clinical experience.

Responsibilities

• Assesses clinical need against guidelines to ensure appropriate level of care for inpatient stay.
• Evaluates necessity and efficiency of medical services and procedures.
• Coordinates and assists in plan implementation for members.
• Monitors services outside the network and negotiates fees as appropriate.
• Coordinates delivery of high quality, cost-effective care across the continuum.

Skills

Analytical

Compassion

Interpersonal Skills

Judgment

Listening

Planning/Priority

Problem Solving

Team Player

Time Management

Written/Oral Communication

Education

Associate or Bachelor degree in nursing or health related field

Accredited diploma nursing school

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a registered nurse to perform care management duties and plan transitions along the continuum of care. You will assess patient needs and coordinate with the care team to optimize outcomes and resource use.

The role involves collaborating with patients, families, physicians, and hospitals, monitoring care across settings, and advocating for the member to ensure cost-effective, high-quality care aligned with guidelines.