RN Care Manager & Clinical Advocate

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); Remote; USD 79,000 - 106,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management duties, coordinate transitions of care, and mentor staff within a collaborative team. You will assess patient needs against guidelines and coordinate services across in-network and out-of-network providers.

The role emphasizes population health, utilization management, and ensuring cost-effective, high-quality patient outcomes. A NJ RN license and experience in health payer settings are required.

Qualifications

• RN experience with established guidelines and care levels
• Ability to mentor and train staff
• Experience with utilization/case/disease management principles

Responsibilities

• Assesses clinical need against guidelines to ensure appropriate level of care
• Evaluates necessity, appropriateness and efficiency of medical services
• Coordinates and implements plans for members
• Monitors services outside the network and negotiates fees as appropriate
• Coordinates with patient, family, physician, hospital and external customers
• Documents accurately based on practice standards
• Interacts with multidisciplinary teams to ensure continuity of care
• Represents clinical teams in committee meetings
• Acts as SME for projects and user acceptance testing

Skills

RN clinical skills

Mentoring

Care coordination

Education

High School Diploma/GED

Bachelor degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management duties, coordinate transitions of care, and mentor staff within a collaborative team. You will assess patient needs against guidelines and coordinate services across in-network and out-of-network providers.

The role emphasizes population health, utilization management, and ensuring cost-effective, high-quality patient outcomes. A NJ RN license and experience in health payer settings are required.