RN II (Field Based - Hudson County)

IntelliResume; 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 field-based nurse reviewer to assess members using established guidelines, ensure medically appropriate services, and develop member-centric plans of care in Hopewell, NJ.

You will evaluate services, coordinate with families, physicians, hospitals, and other care partners, document according to standards, and participate in quality improvement efforts.

Qualifications

• High School Diploma or GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of two years clinical experience required.
• Active Unrestricted NJ RN License required.

Responsibilities

• Assess member's clinical needs against established guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of members' individualized plans of care.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Monitor member's medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and current organization policies.
• Interact and communicate with multidisciplinary teams to strive for continuity and efficiency in care management.
• Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Education

High School Diploma/GED

Bachelor degree preferred or relevant experience in lieu of degree

Job description

About This Role

This field-based position is responsible for performing assessments of members using established guidelines to ensure appropriate levels of care and develop a member-centric plan of care.

Highlights

• Pay: $79,100 - $105,945/year
• Location: Hopewell, NJ
• Schedule: Full-time

What You'll Do

• Assess member's clinical needs against established guidelines to ensure services are medically appropriate.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of members' individualized plans of care.
• Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.
• Monitor member's medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and current organization policies.
• Interact and communicate with multidisciplinary teams to strive for continuity and efficiency in care management.
• Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Requirements

Education

• High School Diploma/GED required
• Bachelor degree preferred or relevant experience in lieu of degree

Experience

• Minimum of two (2) years clinical experience required

Licenses & Certifications

• Active Unrestricted NJ RN License required

Benefits

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

About Horizon Blue Cross Blue Shield NJ

Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health. For over 90 years, they have been New Jersey’s health solutions leader, driving innovations that improve healthcare quality, affordability, and member experience.