RN I, PCA/MDC/DSNP (Field Based - Cape May/Southern Atlantic Counties)

Horizon Blue Cross Blue Shield NJ; Hopewell (NJ); Presencial; USD 71.000 - 94.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Descripción de la vacante

Horizon Blue Cross Blue Shield of New Jersey seeks a field-based RN to perform assessments for PCA and MDC services using guidelines to ensure appropriate levels of care and services are authorized. The role is based in Hopewell, NJ and is full-time.

Responsibilities include evaluating medical necessity, coordinating care, educating members, and documenting outcomes while collaborating with multidisciplinary teams.

Formación

• RN license in New Jersey is required
• Minimum of 2 years clinical experience preferred
• Bachelor's degree preferred or relevant experience in lieu of degree

Responsabilidades

• Assess patient’s clinical need against established guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of services to meet member needs.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Monitor patient’s medical care activities and outcomes for appropriateness and effectiveness.
• Interact and communicate with multidisciplinary teams to ensure continuity of care.

Educación

High School Diploma/GED

Bachelor degree preferred

Descripción del empleo

About This Role

This field-based position is responsible for performing assessments for PCA and MDC services using established guidelines to ensure appropriate levels of care and services are authorized.

Highlights

• Pay: $70,500 - $94,395/year
• Location: Hopewell, NJ
• Schedule: Full-time

What You'll Do

• Assess patient’s clinical need against established guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of services to meet member needs.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Monitor patient’s medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members/families among various sites to coordinate resource utilization.
• Refer members to MLTSS when appropriate.
• Educate members on the availability of SNP if appropriate.
• Document accurately and comprehensively based on standards of practice.
• Interact and communicate with multidisciplinary teams to ensure continuity of care.

Requirements

Education

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree

Experience

• A minimum of two (2) years clinical experience preferred

Licenses & Certifications

• Active Unrestricted NJ RN License required

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

About Horizon Blue Cross Blue Shield NJ

Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health. For over 90 years, they have been New Jersey’s health solutions leader, driving innovations that improve healthcare quality, affordability, and member experience.