RN Care Manager — Chronic Condition & SNP Specialist

Horizon Blue Cross Blue Shield of New Jersey; United States; Teletrabalho; USD 71 000 - 94 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive health benefits (Medical

Dental

Vision

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Resumo da oferta

Horizon Blue Cross Blue Shield of New Jersey seeks a Clinical Advocate RN to lead comprehensive member assessments, authorize services, and monitor care utilization. You will coordinate care across providers and settings while advocating for members, ensuring access to services, and supporting cost-effective care.

Active NJ RN license required; minimum two years clinical nursing and payer experience. Bachelor’s degree preferred.

Qualificações

• High School Diploma or GED required.
• Minimum of two (2) years of clinical nursing experience.
• Minimum of two (2) years of healthcare payer experience.
• Active, unrestricted New Jersey RN license or Compact RN license required.
• Knowledge of case management, care management, and disease management principles.
• Familiarity with MS Office applications (Word, Excel, PowerPoint, Outlook).

Responsabilidades

• Conduct comprehensive member assessments to determine levels of care and service needs.
• Evaluate necessity, appropriateness, and effectiveness of healthcare services.
• Assess clinical needs and support service authorization.
• Coordinate and implement individualized care plans across the continuum of care.
• Advocate for members and families to ensure access to services and resources.
• Maintain accurate documentation and contribute to quality improvement initiatives.

Conhecimentos

Clinical Assessment

Care Coordination

Member Advocacy

Communication

Organization

Teamwork

Adaptability

Formação académica

RN license (NJ)

Bachelor’s degree preferred

Ferramentas

Microsoft Office

Descrição da oferta de emprego

Horizon Blue Cross Blue Shield of New Jersey seeks a Clinical Advocate RN to lead comprehensive member assessments, authorize services, and monitor care utilization. You will coordinate care across providers and settings while advocating for members, ensuring access to services, and supporting cost-effective care.

Active NJ RN license required; minimum two years clinical nursing and payer experience. Bachelor’s degree preferred.