RN Field-Based Care Management Specialist

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

Benefits offered by this job

Comprehensive 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 a field-based RN to perform assessments for PCA and MDC services, ensuring medically appropriate care aligns with benefits. The role requires building coordination with patients, families, physicians and hospitals to optimize outcomes.

Qualifications include NJ RN license, a high school diploma or GED, and 2+ years of clinical experience. Travel is daily and a car with NJ license is required for coverage across the region.

Qualifications

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• A minimum of two (2) years clinical experience is preferred.

Responsibilities

• Assesses patient's clinical need against established guidelines and/or standards to ensure medically appropriate services.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of services to meet member needs.
• Coordinates with patient, family, physician, hospital and other external customers regarding appropriateness of care from diagnosis to outcome.
• Monitors patient's medical care activities and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services.
• Completes NJ Choice Home Care Assessments for new referrals to MLTSS.
• Assists with MLTSS Case Management when necessary.
• Provide support to MLTSS Care Management Staff.
• Evaluates care by problem solving, analyzing variances and participating in quality improvement.

Skills

Analytical

Compassionate

Interpersonal & Client Relationship

Sound Decision Making

Active Listening

Organization/Planning/Priority Setting

Problem Solving/Critical Thinking

Team Player

Time Management

Written/Oral Communication Skills

Education

Bachelor's degree preferred

2+ years clinical experience preferred

Tools

MS Office

Lotus Notes

Job description

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 aligns with benefits. The role requires building coordination with patients, families, physicians and hospitals to optimize outcomes.

Qualifications include NJ RN license, a high school diploma or GED, and 2+ years of clinical experience. Travel is daily and a car with NJ license is required for coverage across the region.