RN II: Case Management & Care Coordination Lead

Horizon Blue Cross Blue Shield of New Jersey; 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

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Advocate RN to perform care management duties, mentor staff, and serve as a subject matter expert on projects and committees. The role includes coordinating care across the continuum, evaluating services, and advocating for members with multidisciplinary teams.

Ideal candidates have a NJ RN license, 2+ years of clinical and payer experience, and CCM certification is preferred.

Qualifications

• High School Diploma or GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of two (2) years clinical experience.

Responsibilities

• Assess patient’s clinical need against guidelines to ensure appropriate level of care for inpatient stay.
• Evaluate necessity, appropriateness, and efficiency of medical services and procedures.
• Coordinate and assist in implementation of plans for members.
• Mentor/train new RNs and staff as needed.
• Act as subject matter expert for projects and committees.
• Represent clinical teams in committee meetings and present required reports.

Skills

Adaptability

Analytical

Compassion

Interpersonal skills

Time management

Written/oral communication

Team player

Education

High School Diploma

Bachelor degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Clinical Advocate RN to perform care management duties, mentor staff, and serve as a subject matter expert on projects and committees. The role includes coordinating care across the continuum, evaluating services, and advocating for members with multidisciplinary teams.

Ideal candidates have a NJ RN license, 2+ years of clinical and payer experience, and CCM certification is preferred.