RN II (Field Based - Gloucester County)

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

About the Role

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of members- individualized plan of care.
• Coordinates with patient, 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.
• 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.
• Encourages member participation and compliance in the program.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
• Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Completes other assigned functions as requested by management.

What You Bring

Education/Experience:

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

Additional licensing, certifications, registrations:

• Active Unrestricted NJ RN License Required.

Knowledge:

• Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel,PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
• Working knowledge of case/care management principles.
• Working knowledge of principles of utilization management.
• Prefers basic knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems.

Skills and Abilities:

• Analytical
• Compassionate
• Interpersonal & Client Relationship Building Skills
• Sound Decision Making
• Active Listening
• Organization/Planning/Priority Setting
• Problem Solving/Critical Thinking
• Team Player
• Time Management
• Written/Oral Communication Skills (Bi-lingual preferred)

Travel (If Applicable):

This is a field based position, daily local travel is required. Requires a car with valid New Jersey State License and Insurance.

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too.

Salary Range

Salary Range: $79,100 - $105,945 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.

Benefits

Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer: Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

About Us

We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too. Our Mission We empower our members to achieve their best health. Our Vision We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.

Equal Opportunity

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity or protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.