RN Field Based Care

Horizon Blue Cross Blue Shield of New Jersey; Elm (PA); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based nurse to assess members and develop individualized plans of care, coordinating with families, physicians and hospitals across the continuum.

Requires an RN license in New Jersey and an associate's or bachelor's degree in nursing, with daily local travel. Strong communication, organization, and documentation skills are essential for delivering high-quality, cost-effective care and ensuring member outcomes.

Qualifications

• Requires an associate or bachelor’s degree (or higher) in nursing and/or accredited diploma nursing school.
• Active Unrestricted NJ RN License Required.
• Proficiency with MS Office and Lotus Notes; knowledge of intranet/internet applications preferred.
• Working knowledge of case/care management principles.
• Prefers knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems.
• Interpersonal & client relationship building skills.
• Organization/Planning/Priority setting.
• Written/Oral communication skills (bi-lingual preferred).

Responsibilities

• Coordinates with patient, family, physician, hospital and other external customers regarding care appropriateness from diagnosis to outcomes.
• Coordinates delivery of high-quality, cost-effective care supported by clinical practice guidelines across the continuum of care.
• Monitors member’s medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for member/family among sites to coordinate resource utilization and evaluation of services.
• Documents accurately and comprehensively based on standards of practice and policies.
• Interacts with multidisciplinary teams via teleconference or in person to ensure continuity of care.
• Understands fiscal accountability and its impact on resource utilization and self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in quality improvement.

Skills

Interpersonal & client relationship

Written/oral communication

Organization/Planning/Priority setting

Bi-lingual preferred

Education

Associate's or Bachelor's degree in nursing

Active NJ RN license

Tools

MS Office (Word/Excel/PowerPoint)

Lotus Notes

Job description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us.

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care. Develops, coordinates and assists in implementation of members- individualized plan of care.

• Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
• Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.

Requires an associates or bachelors degree (or higher) in nursing and/OR accredited diploma nursing school.

Additional licensing, certifications, registrations:

• ~ Active Unrestricted NJ RN License Required

• Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
• Working knowledge of case/care management principles.
• Prefers basic knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems
• Interpersonal & Client Relationship Building Skills
• Organization/Planning/Priority Setting
• Written/Oral Communication Skills (Bi-lingual preferred)

Travel:

This is a field based position, daily local travel is required.

Requires a car with valid New Jersey State License and Insurance

We believe that when our people thrive, our communities do too. 79,100 - $105,945This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Tuition Reimbursement

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.