RN Care Navigator for Chronic Condition Plans

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

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 clinical assessments and authorize services for PCA and MDC programs. You will coordinate care plans, support transitions, and advocate for members to ensure access to needed services.

The role requires an NJ RN license, 2+ years of clinical nursing and payer experience, and strong communication and coordination skills within a multidisciplinary team.

Qualifications

• 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.

Responsibilities

• Perform assessments to determine appropriate levels of care and services.
• Evaluate necessity, appropriateness, and effectiveness of healthcare services.
• Support authorization of services based on standards and program requirements.
• Coordinate and assist with individualized care plans and transitions between care settings.
• Advocate for members and families to access appropriate healthcare services.

Skills

Clinical assessment

Care coordination

Member advocacy

Communication

Organization

Collaboration

Adaptability

Problem solving

Education

High School Diploma or GED

RN license (state or compact)

Bachelor's degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN to perform clinical assessments and authorize services for PCA and MDC programs. You will coordinate care plans, support transitions, and advocate for members to ensure access to needed services.

The role requires an NJ RN license, 2+ years of clinical nursing and payer experience, and strong communication and coordination skills within a multidisciplinary team.