Senior Case Management RN | Care Coordinator Lead

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 79,000 - 106,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Tuition reimbursement

Volunteer time off

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN for Utilization Management. You will assess clinical needs, coordinate care across the continuum, and mentor staff to ensure quality and efficiency. A NJ RN license and payer experience are required, with weekend/holiday rotations. Join a team focused on patient outcomes and cost-effective care.

This role offers comprehensive benefits and opportunities for professional growth within a mission-driven organization.

Qualifications

• Two years clinical experience required.
• Two years’ health care payer experience.
• Active NJ RN License or Compact License required.

Responsibilities

• Assess patient’s clinical need against guidelines to determine inpatient care level.
• Evaluate necessity and efficiency of medical services provided.
• Coordinate and assist in plan implementation for members.
• Monitor services outside the network and negotiate fees as appropriate.
• Mentor/trainer to new RNs and staff; lead projects as SME.
• Present reports at committee meetings; participate in QA programs.
• Subject matter expert for user acceptance testing for medical management system.

Skills

Adaptability/Flexibility

Analytical

Compassion

Interpersonal & Client Relationship Sk

Information/Knowledge Sharing

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organ

Education

Bachelor degree preferred

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced RN for Utilization Management. You will assess clinical needs, coordinate care across the continuum, and mentor staff to ensure quality and efficiency. A NJ RN license and payer experience are required, with weekend/holiday rotations. Join a team focused on patient outcomes and cost-effective care.

This role offers comprehensive benefits and opportunities for professional growth within a mission-driven organization.