RN Case Management Specialist — Care Coordination

Horizon Blue Cross Blue Shield of New Jersey; Parsippany-Troy Hills (NJ); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

Competitive retirement plans

Generous PTO

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced Registered Nurse to perform utilization management and care coordination across the continuum of care for New Jersey members.

You will mentor staff, lead projects, and ensure high-quality, cost-effective care while collaborating with physicians, hospitals, and members. A NJ RN license and payer experience are required, with weekend/holiday coverage as needed.

Qualifications

• Active NJ RN license required.
• Bachelor degree preferred or relevant experience.
• Minimum of two years clinical experience.
• Minimum of two years' health care payer experience.
• CCM certification preferred.

Responsibilities

• Assess patient needs against guidelines to ensure inpatient care is appropriate.
• Evaluate the necessity and efficiency of medical services and procedures.
• Coordinate and implement care plans for members.
• Mentor/train new RNs and staff as needed.
• Act as SME for projects and committees in care management.
• Present reports at committee meetings.
• Support user acceptance testing for medical management systems.

Skills

Clinical nursing

Mentoring

Communication

Critical thinking

Problem solving

Education

NJ RN license

Bachelor degree preferred

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced Registered Nurse to perform utilization management and care coordination across the continuum of care for New Jersey members.

You will mentor staff, lead projects, and ensure high-quality, cost-effective care while collaborating with physicians, hospitals, and members. A NJ RN license and payer experience are required, with weekend/holiday coverage as needed.