RN Care Manager: Elevate Member Care & Outcomes

IntelliResume; New Jersey; Remote; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

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 a Registered Nurse to perform care coordination and plan-of-care activities for the Primary Nurse population. This full-time role is based in Hopewell, NJ and focuses on transitioning to the continuum of care while developing member-centric plans.

The RN will assess clinical needs, coordinate with providers and families, document care, and collaborate with multidisciplinary teams to enhance quality and efficiency.

Qualifications

• Active RN license required or NJ license preferred.
• Experience coordinating care for both acute and chronic conditions.
• Experience with health care payer environment preferred.

Responsibilities

• Assess member's clinical need against guidelines to ensure medically appropriate services.
• Facilitate response to gaps in care and identify high-risk members for wellness visits.
• Evaluate necessity, appropriateness, and efficiency of medical services for acute and chronic needs.
• Develop, coordinate, and implement individualized plans of care for members.
• Coordinate with members, family, physician, and other stakeholders regarding care appropriateness.
• Monitor member's medical care activities and outcomes for effectiveness.
• Advocate for resource utilization and evaluation of services.
• Encourage member participation in disease management programs.
• Document accurately based on standards of practice and policies.
• Interact with multidisciplinary teams to ensure continuity and efficiency.

Skills

RN license

Care coordination

Case management

Documentation

Multidisciplinary collaboration

Education

Nursing degree

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care coordination and plan-of-care activities for the Primary Nurse population. This full-time role is based in Hopewell, NJ and focuses on transitioning to the continuum of care while developing member-centric plans.

The RN will assess clinical needs, coordinate with providers and families, document care, and collaborate with multidisciplinary teams to enhance quality and efficiency.