RN II (Field Based - Passaic 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 NJ in Hopewell, NJ is seeking a field-based RN to assess members against guidelines, ensuring medically appropriate services and developing member-centric plans of care.

You will coordinate with families, physicians, and hospitals, document per policies, and participate in quality improvement while advocating for member needs. A high school diploma with RN license (NJ) and 2+ years clinical experience are required; a bachelor’s degree is preferred.

Qualifications

• High School Diploma or GED required.
• Bachelor's 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 need against guidelines to ensure appropriate services.
• Evaluate necessity, appropriateness, and efficiency of services.
• Develop, coordinate, and implement 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 members/families among various sites to coordinate resource utilization.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and organization policies.
• Interact and communicate with multidisciplinary teams to ensure continuity of care.
• Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Skills

Clinical assessment

Care coordination

Documentation

Interdisciplinary collaboration

Education

High School Diploma/GED

Bachelor's degree preferred

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 need against established guidelines to ensure medically appropriate services.
• Evaluate the necessity, appropriateness, and efficiency of services provided.
• Develop, coordinate, and assist in the implementation of 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 members/families among various sites to coordinate resource utilization.
• Encourage member participation and compliance in the program.
• Document accurately and comprehensively based on standards of practice and organization policies.
• Interact and communicate with multidisciplinary teams to ensure continuity of care.
• 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 health care quality, affordability, and member experience.