Pediatric Case Manager RN: Care Coordination & Outcomes

IntelliResume; New Jersey; 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 is seeking a registered nurse to perform case management duties in Hopewell, NJ. This full-time role focuses on patient outcomes through guideline-driven care planning and transitions in care.

Responsibilities include assessing clinical needs, evaluating services, coordinating care plans, and advocating for member resource utilization. A NJ RN license and 2+ years of clinical experience are required.

Qualifications

• Education: Associate's or Bachelor's degree in nursing or health-related field, or accredited diploma nursing school required.
• Minimum of two (2) years clinical experience.
• Active Unrestricted NJ RN License required.

Responsibilities

• Assess patient’s clinical needs against established guidelines to ensure appropriate care levels.
• Evaluate the necessity, appropriateness, and efficiency of medical services and procedures.
• Coordinate and assist in the implementation of care plans for members.
• Monitor and coordinate services rendered outside of the network and negotiate fees as appropriate.
• Collaborate with patients, families, physicians, and hospitals regarding care appropriateness.
• Deliver high-quality, cost-effective care supported by clinical practice guidelines.
• Monitor patient medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members/families to coordinate resource utilization and service evaluation.
• Encourage member participation and compliance in case/disease management programs.
• Document accurately and comprehensively based on standards of practice and policies.

Education

Associate's or Bachelor's degree in nursing or health-related field; accredited diploma nursing school

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a registered nurse to perform case management duties in Hopewell, NJ. This full-time role focuses on patient outcomes through guideline-driven care planning and transitions in care.

Responsibilities include assessing clinical needs, evaluating services, coordinating care plans, and advocating for member resource utilization. A NJ RN license and 2+ years of clinical experience are required.