RN Care Coordination Specialist - Chronic Condition Plans

100 Horizon Healthcare Services, Inc; Hopewell (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Tuition reimbursement

Wellness programs

Paid volunteer time off

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Advocate to perform assessments for PCA and MDC services and authorize needed care in line with guidelines.

You will coordinate individualized care plans, engage with members and providers, and advocate for access to necessary services while maintaining thorough documentation and contributing to quality improvement initiatives.

Qualifications

• RN license active in New Jersey or Compact state.
• Minimum 2 years clinical nursing experience.
• Minimum 2 years healthcare payer experience.

Responsibilities

• Clinical Assessment & Service Authorization: assess using guidelines to determine appropriate levels of care.
• Care Coordination & Continuum of Care Management: implement care plans and coordinate across providers.
• Member Advocacy & Engagement: advocate for access to services and educate members.
• Collaboration & Communication: partner with physicians, facilities and teams for coordinated care.
• Quality Improvement & Documentation: maintain thorough records and participate in improvement initiatives.
• Clinical Leadership & Professional Support: share knowledge and support processes and projects.

Skills

Clinical assessment

Care coordination

Member advocacy

Critical thinking

Communication

Organization

Collaboration

Adaptability

Education

High School Diploma or GED

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Advocate to perform assessments for PCA and MDC services and authorize needed care in line with guidelines.

You will coordinate individualized care plans, engage with members and providers, and advocate for access to necessary services while maintaining thorough documentation and contributing to quality improvement initiatives.