RN II - Pediatrics

IntelliResume; New Jersey; On-site; USD 79,000 - 106,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an RN Care Manager to plan and coordinate transitions of care for members in Hopewell, NJ, following established guidelines.

You will collaborate with patients, families, physicians, and hospitals, advocate for appropriate resource use, and mentor other RNs while documenting according to policy.

Requirements include NJ RN license (or compact), two years of clinical and payer experience; CCM certification is preferred.

Qualifications

• Active NJ RN license or Compact license required.
• Minimum 2 years of clinical experience.
• Minimum 2 years’ health care payer experience.

Responsibilities

• Coordinate and assist in the implementation of care plans for members.
• Monitor and coordinate services rendered outside of the network.
• Negotiate fees for services as appropriate.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Deliver high-quality, cost-effective care supported by clinical practice guidelines.
• Monitor patient medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members and families to coordinate resource utilization and evaluation of services.
• Encourage member participation in case/disease management programs.
• Document accurately based on standards of practice and organization policies.
• Serve as a mentor/trainer to new RNs and other staff as needed.

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

About This Role

This position is responsible for performing RN duties using established guidelines to ensure appropriate levels of care and planning for transitions in the continuum of care. It is ideal for those who are passionate about patient advocacy and care management.

Highlights

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

What You'll Do

• Coordinate and assist in the implementation of care plans for members.
• Monitor and coordinate services rendered outside of the network.
• Negotiate fees for services as appropriate.
• Coordinate with patients, families, physicians, and hospitals regarding care appropriateness.
• Deliver high-quality, cost-effective care supported by clinical practice guidelines.
• Monitor patient medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members and families to coordinate resource utilization and evaluation of services.
• Encourage member participation in case/disease management programs.
• Document accurately based on standards of practice and organization policies.
• Serve as a mentor/trainer to new RNs and other staff as needed.

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
• Minimum of two (2) years’ experience with health care payer experience

Licenses & Certifications:

• Active Unrestricted NJ RN License or active Compact License required
• CCM certification preferred

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 is a leading healthcare provider committed to delivering exceptional patient care. For over 90 years, they have been New Jersey’s health solutions leader, driving innovations that improve healthcare quality, affordability, and member experience.