Pediatric RN Case Manager - Care Coordination

100 Horizon Healthcare Services, Inc; 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 BCBSNJ in New Jersey seeks an experienced RN to perform care management duties within established guidelines, planning the continuum of care for members. You will assess clinical needs, evaluate services, and coordinate plans with patients, families, and providers to ensure appropriate inpatient care.

The role requires an active NJ RN license and at least two years of clinical experience, with proficiency in MS Office and healthcare contracts knowledge.

Qualifications

• Requires an associates or bachelors degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.
• Requires a minimum of two (2) years clinical experience.
• Active Unrestricted NJ RN License Required; knowledge of MS Office and basic computer skills preferred.

Responsibilities

• Assesses patient's clinical need against guidelines to ensure appropriate level of care for inpatient stay.
• Evaluates necessity, appropriateness and efficiency of medical services and procedures.
• Coordinates and assists in implementation of plan for members.
• Monitors and coordinates services outside the network and negotiates fees as appropriate.
• Coordinates with patient, family, physician, hospital and external customers regarding care.
• Delivers high quality, cost-effective care per plan across the continuum.
• Monitors medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for member/family among sites to optimize resource use.
• Encourages member participation in case/disease management efforts.
• Documents accurately per standards and policies.
• Interacts with multidisciplinary teams to ensure continuity of care.
• Understands fiscal accountability and its impact on resources.
• Participates in quality improvement to enhance member outcomes.
• Completes other functions as requested by management.

Skills

Analytical

Compassion

Interpersonal & Client Relationship

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organ

Education

Associates or Bachelors in nursing or health field

Tools

MS Office

Windows

Intranet/Internet apps

Job description

Horizon BCBSNJ in New Jersey seeks an experienced RN to perform care management duties within established guidelines, planning the continuum of care for members. You will assess clinical needs, evaluate services, and coordinate plans with patients, families, and providers to ensure appropriate inpatient care.

The role requires an active NJ RN license and at least two years of clinical experience, with proficiency in MS Office and healthcare contracts knowledge.