RN I, PCA/MDC/DSNP (Field-Based - Hudson County)

IntelliResume; Newark (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 assess and authorize PCA and MDC services following established guidelines.

You will work in Newark, NJ, full-time, with compensation in the advertised pay range. The role focuses on evaluating medical necessity, coordinating services, and advocating for members across care settings to ensure appropriate utilization and quality outcomes.

Qualifications

• High School Diploma/GED required; Bachelor degree preferred.
• Minimum two (2) years of clinical experience preferred.

Responsibilities

• 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, hospitals, and other external customers 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.

Skills

Clinical assessment

Care coordination

Communication

Advocacy

Documentation

Education

High School Diploma/GED

Bachelor's degree

Job description

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: Newark, 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, hospitals, and other external customers 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.