RN II: Primary Care & Care Coordination

Horizon Blue Cross Blue Shield; New Jersey; Hybrid; 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 Registered Nurse to perform clinical care management for a primary nurse population. The role includes planning for transitions of care, mentoring new staff, and outreach to high‑risk members to promote preventive care and screenings.

Some travel to on-site locations may be required. Responsibilities include assessing needs, coordinating care with providers, and ensuring quality and cost-effective services across the continuum of care,

Qualifications

• Active Unrestricted RN license required.
• Minimum of two (2) years clinical experience; payer experience preferred.
• Bachelor degree preferred or relevant experience in lieu of degree.

Responsibilities

• Assess member's clinical need against guidelines to ensure medically appropriate care.
• Facilitate gaps in care and engage high-risk members in annual wellness visits.
• Evaluate necessity and efficiency of medical services for acute and chronic needs.
• Develop, coordinate, and implement individualized plans of care for members.
• Coordinate with members, families, physicians, hospitals and external customers regarding care from diagnosis to outcome.
• Monitor care activities and outcomes for appropriateness and effectiveness.

Education

RN License Required

Bachelor degree preferred

Tools

MS Office

Intranet & Internet applications

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform clinical care management for a primary nurse population. The role includes planning for transitions of care, mentoring new staff, and outreach to high‑risk members to promote preventive care and screenings.

Some travel to on-site locations may be required. Responsibilities include assessing needs, coordinating care with providers, and ensuring quality and cost-effective services across the continuum of care,