RN II Case Manager — Care Coordination & Mentorship

Horizon Blue Cross Blue Shield NJ; New Jersey; 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 NJ is seeking an experienced RN to provide clinical assessments, care planning, and coordination for members, ensuring appropriate care levels and smooth transitions.

Ideal candidates will mentor other RNs, participate in case management, and collaborate with physicians, hospitals, and families to optimize resource use. A bachelor’s degree is preferred and at least two years of clinical and payer experience are required.

Qualifications

• Minimum of two (2) years clinical experience.
• Minimum of two (2) years’ experience with health care payer experience.

Responsibilities

• Assess patient’s clinical needs against guidelines to ensure appropriate care levels.
• Evaluate necessity and efficiency of medical services and procedures.
• Coordinate and assist in care plan implementation for members.
• Monitor and coordinate services outside the network and negotiate fees as appropriate.
• Coordinate with patients, families, physicians, and hospitals regarding care.
• Advocate for members and families to optimize resource utilization.
• Document accurately based on standards and policies.
• Interact with multidisciplinary teams to ensure continuity of care.
• Evaluate care through quality improvement programs.
• Serve as a mentor/trainer to new RNs and staff.

Skills

RN duties

Case management

Mentoring

Education

Bachelor's degree

Job description

Horizon Blue Cross Blue Shield NJ is seeking an experienced RN to provide clinical assessments, care planning, and coordination for members, ensuring appropriate care levels and smooth transitions.

Ideal candidates will mentor other RNs, participate in case management, and collaborate with physicians, hospitals, and families to optimize resource use. A bachelor’s degree is preferred and at least two years of clinical and payer experience are required.