RN Care Navigator: PCA/MDC/DSNP (Field-Based)

Horizon Blue Cross Blue Shield; New Jersey; Vor Ort; USD 71.000 - 94.000; Vollzeit

Benefits dieser Stelle

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Tuition Reimbursement

Paid Volunteer Time Off

Zusammenfassung

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to perform assessments for PCA and MDC services, ensuring medically appropriate care and aligning with benefit structures. You will evaluate services, coordinate across providers, educate members, and document with precision while supporting MLTSS caseloads.

Qualified candidates hold an active NJ RN license and at least a high school diploma with preferred bachelor’s degree.

Qualifikationen

• Active Unrestricted NJ RN License required.
• High school diploma or GED required; bachelor's degree preferred.
• Clinical experience in case management and utilization preferred.

Aufgaben

• Assess patient care needs against guidelines to ensure medical appropriateness.
• Coordinate services across diagnosing, hospital, and community settings.
• Educate members about SNP and NJ Choice Home Care programs.
• Document accurately per organizational policies and standards.
• Support MLTSS caseloads and care management activities as needed.
• Participate in quality improvement to enhance member outcomes.
• Travel daily within NJ for field-based assessments.

Kenntnisse

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Planning

Problem solving

Team player

Time management

Communication

Ausbildung

High School Diploma/GED

Bachelor degree preferred

Tools

MS Office

Lotus Notes

Jobbeschreibung

Horizon Blue Cross Blue Shield of New Jersey is seeking a field-based RN to perform assessments for PCA and MDC services, ensuring medically appropriate care and aligning with benefit structures. You will evaluate services, coordinate across providers, educate members, and document with precision while supporting MLTSS caseloads.

Qualified candidates hold an active NJ RN license and at least a high school diploma with preferred bachelor’s degree.