RN Care Manager - Care Coordination & Transitions

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; 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 is seeking an experienced RN to perform primary nurse population care management using established guidelines to ensure appropriate care and planning for the continuum of care. You will outreach to high risk members, engage them in preventive care, coordinate with multidisciplinary teams, and mentor other staff.

Travel may be required for on-site visits. This role emphasizes collaboration, care coordination, and adherence to plan guidelines to improve

Qualifications

• Requires associate’s or bachelor’s degree in nursing and/or a health related field OR accredited diploma nursing school.
• Requires a minimum of two (2) years clinical experience. Experience with both acute and chronic conditions preferred.
• Requires a minimum of three (3) years’ experience in the health care delivery system/industry.
• Experience with health care payer experience strongly preferred.

Responsibilities

• Assesses member’s clinical need against established guidelines and/or standards to ensure medically appropriate services.
• Facilitates response to gaps in care for high risk members and coordinate annual wellness visits with treating provider.
• Evaluates necessity and efficiency of medical services for acute and chronic needs.
• Develops and coordinates individualized plan of care and self-management support.
• Coordinates with members, family, physician, hospital and external customers for care from diagnosis to outcome.
• Manages continuity of care and transitional care within the network.

Skills

Bi-lingual proficiency

Adaptability/Flexibility

Analytical

Compassion

Information/Knowledge Sharing

Interpersonal & Client Relationship

Sound decision making

Active listening

Organization Planning/Priority Setting

Problem Solving/Critical Thinking

Team Player

Time Management

Written/Oral Communications

Education

Associate’s or Bachelor’s degree in nursing or health-related field

Minimum of two years clinical experience

Minimum of three years in health care delivery system/industry

Health care payer experience preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN to perform primary nurse population care management using established guidelines to ensure appropriate care and planning for the continuum of care. You will outreach to high risk members, engage them in preventive care, coordinate with multidisciplinary teams, and mentor other staff.

Travel may be required for on-site visits. This role emphasizes collaboration, care coordination, and adherence to plan guidelines to improve