RN II: Care Management & Transitional Care

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; 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 seeking an RN to perform case management duties for the Primary Nurse population. The role focuses on planning transitions to the continuum of care and developing member-centric plans of care.

You will outreach to high-risk members and engage them in preventative care opportunities and screenings. As a mentor to new RNs and staff, you will coordinate care with providers, facilities and families, while traveling to on-site locations as needed.

Qualifications

• 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. Experience with both acute and chronic conditions preferred.
• Requires a minimum of three (3) years’ experience in the health care delivery system/industry.
• Experience with health care payer experience strongly preferred.

Responsibilities

• Assesses member’s clinical need against guidelines to ensure medically appropriate services.
• Facilitates response to gaps in care and high risk members for wellness visits.
• Evaluates necessity and efficiency of medical services for acute and chronic needs.
• Develops and coordinates individualized plan of care for members.
• Coordinates with members, families, physicians, hospitals and external customers on care.
• Delivers high quality, cost-effective care aligned with guidelines across continuum of care.
• Monitors care activities and outcomes for appropriateness and effectiveness.
• Advocates for member/family among sites to coordinate resources.
• Encourages participation in disease management programs.
• Documents accurately per standards and policies.
• Interacts with multidisciplinary teams to ensure continuity of care.
• Participates in quality improvement to enhance outcomes.
• Presents cases during audits and performs other duties as assigned.

Skills

Bi-lingual proficiency

Adaptability/Flexibility

Analytical

Compassion

Information/Knowledge Sharing

Interpersonal & Client Relationship

Sound decision making

Active listening

Organization Planning/Priority Setting

Problem Solving/Critical Thinking

Team Player

Time Management

Written/Oral Communications

Education

Bachelor degree preferred

Two or more years clinical experience

Three years in health care delivery system/industry

Tools

MS Office (Word, Excel, PowerPoint)

Outlook

Intranet/Internet applications

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an RN to perform case management duties for the Primary Nurse population. The role focuses on planning transitions to the continuum of care and developing member-centric plans of care.

You will outreach to high-risk members and engage them in preventative care opportunities and screenings. As a mentor to new RNs and staff, you will coordinate care with providers, facilities and families, while traveling to on-site locations as needed.