RN Pediatric Care Coordinator – Case Management

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 71,000 - 94,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management duties, assess care needs, and coordinate plans across the continuum of care. The role emphasizes value-based, patient-centered care and collaboration with multidisciplinary teams.

Requires 2+ years clinical experience, an active NJ RN license, and a nursing degree. Knowledge of MS Office and utilization principles is preferred.

Qualifications

• Requires an associates or bachelors degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.
• Requires a minimum of two (2) years clinical experience.
• Active Unrestricted NJ RN License Required

Responsibilities

• Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
• Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
• Coordinates and assists in implementation of plan for members.
• Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate.

Skills

Analytical

Compassion

Interpersonal & Client Relationship

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organis

Education

Associates or Bachelors degree in Nursing or health-related field

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management duties, assess care needs, and coordinate plans across the continuum of care. The role emphasizes value-based, patient-centered care and collaboration with multidisciplinary teams.

Requires 2+ years clinical experience, an active NJ RN license, and a nursing degree. Knowledge of MS Office and utilization principles is preferred.