RN I

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 an RN to perform care management duties within established guidelines, coordinating the continuum of care for members in New Jersey. The role requires an active NJ RN license or a Compact license, strong analytical and communication skills, and experience in coordinating multidisciplinary teams.

Primary responsibilities include assessing clinical needs, evaluating services, and guiding members through the care pathway, while maintaining

Qualifications

• High School Diploma or GED is required.
• Bachelor's degree preferred or relevant experience in lieu of degree.
• Active Unrestricted NJ RN License or active Compact License is required.
• Prefers familiarity with MS Office and intranet/internet applications.

Responsibilities

• Assesses patient's clinical need against guidelines to ensure appropriate inpatient care.
• Evaluates necessity and efficiency of medical services and procedures.
• Coordinates and assists in care transition planning for members.
• Monitors services outside network and negotiates fees as appropriate.
• Coordinates with patient, family, physician, hospital and external parties for care.
• Documents accurately per standards and supports continuity of care.

Skills

Analytical

Compassion

Interpersonal & Client Relationship

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organ. Sk

Education

High School Diploma/GED

Bachelor's degree preferred

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. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.About the RoleThis position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.What You'll DoResponsibilities:Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.Coordinates and assists in implementation of plan for members.Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. 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 patient'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.Encourages member participation and compliance in the case/disease management program efforts.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.Completes other assigned functions as requested by management.What You BringEducation/Experience:High School Diploma/GED required.Bachelor's degree preferred or relevant experience in lieu of degree.Requires a minimum of two (2) years clinical experience.Active Unrestricted NJ RN License or active Compact License Required.Knowledge:Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook) prefers knowledge in the use of intranet and internet applications.Prefers working knowledge of case/care management principles.Prefers working knowledge of principles of utilization management.Prefers basic knowledge of health care contracts and benefit eligibility requirements.Prefers knowledge of hospital structures and payment systems.Skills and Abilities:AnalyticalCompassionInterpersonal & Client Relationship SkillsJudgmentListeningPlanning/Priority SettingProblem SolvingTeam PlayerTime ManagementWritten/Oral Communication & Organizational SkillsWhy Horizon?At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!Salary Range:$70,500 - $94,395This 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. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:Comprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition ReimbursementDisclaimer:Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. 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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.