RN II: Care Coordination & Outcomes Advocate

100 Horizon Healthcare Services, Inc; Hopewell (NJ); On-site; USD 79,000 - 106,000; 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 hiring a field-based RN case manager to assess and coordinate care for members, ensuring services are medically appropriate and cost-effective across the continuum of care.

The role requires an active NJ RN license, a high school diploma (Bachelor's preferred), at least two years of clinical experience, and strong skills in communication, problem solving, and collaboration with multidisciplinary teams.

Qualifications

• High School Diploma/GED required; Bachelor degree preferred or relevant experience.
• Active Unrestricted NJ RN License required.
• Minimum of two years clinical experience.
• Proficiency with Windows/Microsoft Office and basic knowledge of case/care management.

Responsibilities

• Assess member's clinical need against guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness and efficiency of services.
• Develop and implement members' individualized plan of care.
• Coordinate with patient, family, physician, hospital and other external customers.
• Monitor medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for member/family to coordinate resource utilization.
• Encourage member participation in the program.
• Document accurately based on standards and policies.
• Interact with multidisciplinary teams to ensure continuity of care.
• Participate in quality improvement program to enhance member outcomes.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization

Problem solving

Team player

Time management

Written/oral communication

Education

Bachelor's degree preferred

High School Diploma/GED required

Job description

Horizon Blue Cross Blue Shield of New Jersey is hiring a field-based RN case manager to assess and coordinate care for members, ensuring services are medically appropriate and cost-effective across the continuum of care.

The role requires an active NJ RN license, a high school diploma (Bachelor's preferred), at least two years of clinical experience, and strong skills in communication, problem solving, and collaboration with multidisciplinary teams.