Pediatric RN Case Manager: Care Coordination & Outcomes

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; 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 an experienced Registered Nurse to perform care management duties within established guidelines, planning transitions across the continuum of care and ensuring appropriate level of care for members.

You will assess clinical needs, coordinate services, monitor outside-network care, advocate for members, document thoroughly, and collaborate with multidisciplinary teams to drive quality and cost-effective outcomes.

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.
• Prefers knowledge of case/care management principles and utilization management.

Responsibilities

• Assesses patient's clinical need against guidelines to ensure appropriate inpatient stay.
• Evaluates the necessity and efficiency of medical services and procedures.
• Coordinates and assists in implementation of plan for members.
• Monitors services outside the network and negotiates fees as appropriate.
• Coordinates care across sites and with multidisciplinary teams for continuum of care.
• Documents accurately based on standards of practice and policies.
• Advocates for members and engages in case/disease management efforts.
• Supports continuity and efficiency of member care along the continuum.

Skills

Analytical

Compassion

Interpersonal skills

Judgment

Listening

Planning/Priority setting

Problem solving

Team player

Time management

Written/Oral communication

Education

Nursing degree (ADN/BSN)

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced Registered Nurse to perform care management duties within established guidelines, planning transitions across the continuum of care and ensuring appropriate level of care for members.

You will assess clinical needs, coordinate services, monitor outside-network care, advocate for members, document thoroughly, and collaborate with multidisciplinary teams to drive quality and cost-effective outcomes.