Senior Care Coordination Nurse | Case Management & Wellness

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 79,000 - 106,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management for the Primary Nurse population, ensuring appropriate care levels and transitioning planning along the continuum. The role includes mentoring staff and supporting ASO accounts with travel as needed.

You will work with a team to assess clinical needs, coordinate care across providers, and develop individualized care plans while promoting preventative care and wellness opportunities.

Qualifications

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of two (2) years clinical experience. Experience with both acute and chronic conditions preferred.
• Requires a minimum of three (3) years' experience in the health care delivery system/industry.
• Experience with health care payer experience strongly preferred.

Responsibilities

• Assesss member's clinical need against guidelines to ensure medically appropriate services.
• Facilitate response to gaps in care for high risk members and coordinate annual wellness visits.
• Evaluate necessity, appropriateness and efficiency of medical services.
• Develop and implement individualized plan of care and support self-management.
• Coordinate with members, family, physicians, hospitals and external parties on care.
• Ensure high quality, cost-effective care aligned with care continuum and guidelines.
• Monitor care activities and outcomes for appropriateness and effectiveness.
• Advocate for member/family across sites to optimize resource use.
• Encourage participation in disease/care management programs.
• Document thoroughly per standards and policies.
• Interact with multidisciplinary teams to ensure continuity of care.
• Participate in audits and quality improvement activities.

Skills

RN experience

Clinical assessment

Care coordination

Communication skills

Team player

Education

RN license

BSN preferred

Tools

MS Office

Healthcare IT systems

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Registered Nurse to perform care management for the Primary Nurse population, ensuring appropriate care levels and transitioning planning along the continuum. The role includes mentoring staff and supporting ASO accounts with travel as needed.

You will work with a team to assess clinical needs, coordinate care across providers, and develop individualized care plans while promoting preventative care and wellness opportunities.