RN Care Manager & Care Coordination Expert

100 Horizon Healthcare Services, Inc; Hopewell (NJ); Remote; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

Paid time off

Retirement plans

Incentive plans

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced Registered Nurse in a Clinical Advocate role to manage complex cases and mentor staff across the continuum of care. The role focuses on evaluating clinical needs, coordinating services, and ensuring high-quality, cost-effective care within guidelines.

You will coordinate with patients, families, physicians, and external partners, advocating for appropriate utilization and outcomes in a fast-paced setting.

Qualifications

• RN license active in NJ or Compact State
• Minimum 2 years clinical experience
• Healthcare payer experience preferred
• CCM certification preferred (addendum)
• Bachelor degree preferred or relevant experience

Responsibilities

• Assess clinical needs against guidelines for inpatient stay appropriateness
• Coordinate and implement care plans across providers
• Advocate for members across sites and payers
• Mentor/trainer to new RN staff
• Contribute to quality improvement initiatives

Skills

RN experience

Communication skills

Team collaboration

Motivational interviewing

Education

Nursing RN license

Bachelor’s degree preferred

Tools

MS Office

Windows OS

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced Registered Nurse in a Clinical Advocate role to manage complex cases and mentor staff across the continuum of care. The role focuses on evaluating clinical needs, coordinating services, and ensuring high-quality, cost-effective care within guidelines.

You will coordinate with patients, families, physicians, and external partners, advocating for appropriate utilization and outcomes in a fast-paced setting.