RN II Oncology Care Navigator & Mentor

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); Remote; USD 85,000 - 110,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced RN Utilization Management professional to perform case management and coordinate care across the continuum. You will mentor staff, act as SME on projects, and collaborate with multidisciplinary teams to optimize member outcomes.

Requires NJ RN license, 2+ years clinical and payer experience; bachelor degree preferred. This on-site role offers exposure to a broad range of care-management initiatives within a leading insurer.

Qualifications

• Active NJ RN license is required.
• Minimum of two (2) years of clinical experience.
• Minimum of two (2) years’ experience with health care payer experience.
• Bachelor degree preferred or relevant experience in lieu of degree.

Responsibilities

• Assesses patient’s clinical need against guidelines to ensure appropriate care level for inpatient stay.
• Evaluates necessity, appropriateness and efficiency of medical services and procedures.
• Coordinates and assists in implementation of plan for members.
• Monitors and coordinates services outside the network and negotiates fees as appropriate.
• Coordinates the delivery of high-quality, cost-effective care across the continuum of care.
• Interacts with multidisciplinary teams to ensure continuity and efficiency in member management.
• Acts as mentor/trainer to new RNs and other staff.
• Represents clinical teams in committee meetings and reports to committees.

Skills

NJ RN License

Case management

Utilization management

Mentoring

Interdisciplinary collaboration

Education

Bachelor degree preferred

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced RN Utilization Management professional to perform case management and coordinate care across the continuum. You will mentor staff, act as SME on projects, and collaborate with multidisciplinary teams to optimize member outcomes.

Requires NJ RN license, 2+ years clinical and payer experience; bachelor degree preferred. This on-site role offers exposure to a broad range of care-management initiatives within a leading insurer.