RN Care Manager: Advanced Care Coordination & Transitions

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 79,000 - 106,000; 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 seeks an experienced RN for care management across the continuum of care. You will assess needs, develop patient-centered care plans, and coordinate with providers and families to ensure quality outcomes.

The role emphasizes mentorship, adherence to guidelines, and engagement of high-risk members in preventive care and wellness activities. On-site NJ-based position with strong team collaboration.

Qualifications

• Requires an associate's or bachelor's degree in nursing or accredited diploma program.
• Minimum of two years clinical experience; experience with acute and chronic conditions preferred.
• Three years in the health care delivery system/industry; payer experience preferred.

Responsibilities

• Assess member's clinical need against guidelines to ensure medically appropriate care.
• Facilitate gaps in care and high-risk member outreach for wellness visits.
• Evaluate necessity and efficiency of medical services for acute and chronic needs.
• Develop and coordinate individualized plans of care and barriers to self-management.
• Coordinate care with members, families, physicians, hospitals and external parties.
• Oversee delivery of high-quality, cost-effective care across continuum.
• Monitor care activities and outcomes for appropriateness and effectiveness.
• Advocate for member/family across sites to optimize resource use.
• Encourage member participation in case/disease management.
• Document according to practice standards and policy.
• Collaborate with multidisciplinary teams to ensure continuity of care.
• Evaluate care through problem solving and quality improvement initiatives.
• Mentor/trainer to new RNs and other staff as needed.
• Spearhead clinical case presentations during external audits.

Skills

Bi-lingual proficiency

Adaptability

Analytical

Compassion

Interpersonal skills

Team player

Time management

Written/Oral communications

Education

Associate or Bachelor degree in nursing

Accredited nursing program

Tools

MS Office

PC proficiency

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced RN for care management across the continuum of care. You will assess needs, develop patient-centered care plans, and coordinate with providers and families to ensure quality outcomes.

The role emphasizes mentorship, adherence to guidelines, and engagement of high-risk members in preventive care and wellness activities. On-site NJ-based position with strong team collaboration.