RN Care Manager: Elevate Care & Transitions

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); 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 seeks an experienced RN to manage care for the Primary Nurse population, plan transitions, and develop member-centric care plans. You will mentor other RNs and outreach to high-risk members for wellness opportunities.

Requires an associate's or bachelor's degree in nursing, 2+ years clinical experience, and 3+ years in healthcare; payer experience preferred. MS Office skills and bilingual ability are pluses. NJ-based role with comprehensive benefits.

Qualifications

• Requires an associate's or bachelor's degree in nursing 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 guidelines to ensure services are medically appropriate.
• Facilitates gaps in care for high risk members and coordinates wellness visits.
• Evaluates necessity and efficiency of medical services for acute and chronic needs.
• Develops individualized care plans and promotes self-management and wellness.
• Coordinates with members, families, physicians, hospitals and external stakeholders.
• Delivers high-quality, cost-effective care aligned with guidelines across the continuum of care.
• Monitors care activities and outcomes for appropriateness.
• Advocates for members across sites to optimize resource use.
• Encourages participation in case/disease management.
• Documents according to standards and policy.

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

Nursing degree (associate/bachelor or diploma)

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced RN to manage care for the Primary Nurse population, plan transitions, and develop member-centric care plans. You will mentor other RNs and outreach to high-risk members for wellness opportunities.

Requires an associate's or bachelor's degree in nursing, 2+ years clinical experience, and 3+ years in healthcare; payer experience preferred. MS Office skills and bilingual ability are pluses. NJ-based role with comprehensive benefits.