RN: Care Management & Care Coordination

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 RN to perform care management duties within established guidelines, coordinating the continuum of care for members in New Jersey. The role requires an active NJ RN license or a Compact license, strong analytical and communication skills, and experience in coordinating multidisciplinary teams.

Primary responsibilities include assessing clinical needs, evaluating services, and guiding members through the care pathway, while maintaining

Qualifications

• High School Diploma or GED is required.
• Bachelor's degree preferred or relevant experience in lieu of degree.
• Active Unrestricted NJ RN License or active Compact License is required.
• Prefers familiarity with MS Office and intranet/internet applications.

Responsibilities

• Assesses patient's clinical need against guidelines to ensure appropriate inpatient care.
• Evaluates necessity and efficiency of medical services and procedures.
• Coordinates and assists in care transition planning for members.
• Monitors services outside network and negotiates fees as appropriate.
• Coordinates with patient, family, physician, hospital and external parties for care.
• Documents accurately per standards and supports continuity of care.

Skills

Analytical

Compassion

Interpersonal & Client Relationship

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organ. Sk

Education

High School Diploma/GED

Bachelor's degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an RN to perform care management duties within established guidelines, coordinating the continuum of care for members in New Jersey. The role requires an active NJ RN license or a Compact license, strong analytical and communication skills, and experience in coordinating multidisciplinary teams.

Primary responsibilities include assessing clinical needs, evaluating services, and guiding members through the care pathway, while maintaining