RN Field Based Care

Horizon Blue Cross Blue Shield of New Jersey; New Jersey; 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 is seeking a field-based nurse case manager to assess members, develop care plans, and coordinate services across settings. You will work with patients, families, physicians, and providers to ensure appropriate, high-quality care.

Requirements include an associates or bachelor's degree in nursing, an active NJ RN license, strong communication, and ability to travel daily with a personal vehicle in New Jersey.

Qualifications

• Active Unrestricted NJ RN License
• Associates or Bachelor's degree in nursing (or higher)
• Field-based position requiring daily local travel and a car with NJ license and insurance
• Bi-lingual skills preferred

Responsibilities

• Assess members using established guidelines and develop member-centric plans of care.
• Coordinate care with patients, families, physicians, hospitals and external providers.
• Monitor care activities and outcomes for appropriateness and effectiveness.
• Advocate for members across sites to optimize resource utilization.
• Document accurately according to policies and practice standards.

Skills

Interpersonal & Client Relationship

Organization/Planning/Priority Setting

Written/Oral Communication

Education

Associate or Bachelor's degree in nursing

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.