RN II (Field Based - Middlesex County)

Horizon Blue Cross Blue Shield; 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 of New Jersey is seeking a field-based RN care manager to assess members against guidelines and develop individualized plans of care. The role involves coordination with families, physicians, and facilities to ensure appropriate, cost-effective care across the continuum.

Qualified candidates have a NJ RN license, a minimum of two years clinical experience, and a high school diploma or GED (Bachelor's degree preferred). Travel within the region is required.

Qualifications

• High School Diploma or GED required; Bachelor's degree preferred.
• Active NJ RN License required.
• Minimum of two years clinical experience.

Responsibilities

• Assesses clinical need against guidelines to ensure medically appropriate care.
• Evaluates necessity and efficiency of services provided.
• Develops and coordinates member’s individualized plan of care.
• Coordinates with patient, family, physician, hospital and external stakeholders about care appropriateness.
• Monitors care activities and outcomes for appropriateness and effectiveness.
• Advocates for the member/family across care sites to coordinate resources.
• Documents accurately per standards and policies.
• Interacts with multidisciplinary teams to ensure continuity and efficiency of care.
• Understands fiscal accountability and resource utilization.
• Contributes to quality improvement programs.

Skills

Analytical

Compassionate

Interpersonal skills

Decision making

Active listening

Organization & planning

Problem solving

Team player

Time management

Communication skills

Education

High School Diploma/GED

Bachelor degree

Tools

Windows

MS Office (Word, Excel, PowerPoint)

Lotus Notes

Job description

About the Role

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

What You’ll Do

• 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

$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

• 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.

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, 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.

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.

Mission

We empower our members to achieve their best health.

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.