RN II Care Manager: High-Impact Patient Transitions

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

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 Registered Nurse to manage the Primary Nurse population following established guidelines and develop member-centric care plans. The role includes outreach to high-risk members and coordinating transitions across the continuum of care, with potential travel for on-site ASO accounts.

The RN will mentor staff, assess care needs against guidelines, and collaborate with treating providers to ensure appropriate services and optimal wellness for

Qualifications

• High School Diploma/GED required.
• Bachelor 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 established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure.
• Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider.
• Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs.
• Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness.
• Coordinates with members, 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 including transitional care.
• Monitors member'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.

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to manage the Primary Nurse population following established guidelines and develop member-centric care plans. The role includes outreach to high-risk members and coordinating transitions across the continuum of care, with potential travel for on-site ASO accounts.

The RN will mentor staff, assess care needs against guidelines, and collaborate with treating providers to ensure appropriate services and optimal wellness for