Remote RN: Chronic Condition Care Navigator

Horizon Blue Cross Blue Shield; New Jersey, United States, Northern America, Americas; Hybrid; USD 71,000 - 94,000; Full time

Benefits offered by this job

Health benefits

Retirement Plans

Generous PTO

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an RN I for PCA/MDC/SNP roles in a remote full-time capacity. This role conducts comprehensive member assessments and supports authorization of services to ensure appropriate care.

You will collaborate with physicians, care teams, and family members to coordinate services across the continuum of care, advocate for members, document thoroughly, and contribute to quality improvement efforts. RN license in NJ or compact required.

Qualifications

• Familiarity with case management, care management, and disease management principles.
• Working knowledge of utilization management processes and practices.
• Knowledge of healthcare contracts and benefit eligibility requirements.
• Knowledge of hospital operations and healthcare reimbursement systems.
• Proficiency with Microsoft Office applications and related tools.

Responsibilities

• Conduct comprehensive member assessments to determine needs and authorize services.
• Evaluate necessity, appropriateness, and effectiveness of healthcare services per guidelines.
• Coordinate care plans and facilitate transitions across the continuum of care.
• Advocate for members and assist with enrollment and navigation of benefits.
• Collaborate with physicians, hospitals, and care teams to ensure coordinated care.
• Maintain accurate documentation and participate in quality improvement initiatives.

Skills

Clinical Assessment

Care Coordination

Member Advocacy

Communication

Organization

Teamwork

Adaptability

Problem Solving

Education

High School Diploma or GED

Bachelor's degree preferred

Certified Case Manager CCM certification preferred

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an RN I for PCA/MDC/SNP roles in a remote full-time capacity. This role conducts comprehensive member assessments and supports authorization of services to ensure appropriate care.

You will collaborate with physicians, care teams, and family members to coordinate services across the continuum of care, advocate for members, document thoroughly, and contribute to quality improvement efforts. RN license in NJ or compact required.