Pediatric RN Case Manager: Care Coordination & Transitions

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Dental/Vision

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is hiring an RN to perform care management duties under established guidelines, planning for transition to the continuum of care. You will assess, coordinate and monitor patient care across the network and beyond.

Requires an associate or bachelor's in nursing, and an active NJ RN license, with at least two years of clinical experience. Candidate should be proficient with Windows applications and familiar with case/care and utilization management

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 proficiency with MS Office and general computer skills.
• Knowledge of case/care management and utilization management principles is preferred.

Responsibilities

• Assess patient clinical needs against guidelines to ensure appropriate level of care and length of stay for inpatient care.
• Evaluate necessity, appropriateness and efficiency of medical services and procedures.
• Coordinate and assist in implementing the plan for members.
• Monitor and coordinate services outside the network and negotiate fees as appropriate.
• Coordinate high quality, cost-effective care across the continuum of care.
• Document accurately based on standards and policies.
• Collaborate with multidisciplinary teams to ensure continuity of care.

Skills

Analytical

Compassion

Interpersonal & Client Relationship

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organis

Education

Associates or Bachelors in nursing

Active NJ RN License

Job description

Horizon Blue Cross Blue Shield of New Jersey is hiring an RN to perform care management duties under established guidelines, planning for transition to the continuum of care. You will assess, coordinate and monitor patient care across the network and beyond.

Requires an associate or bachelor's in nursing, and an active NJ RN license, with at least two years of clinical experience. Candidate should be proficient with Windows applications and familiar with case/care and utilization management