RN I, PCA/MDC/DSNP

Vaga não está no LinkedIn

🕒 Julho 27

🦌 Connecticut, New Jersey, +2 estados a mais – Remoto

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $70.500 - $94.395 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🚫👨‍🎓 Sem graduação necessária

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Horizon Connect @ Wall BCBSNJ

SiteLinkedInTodas as Vagas

2 - 10 funcionários

⚕️ Seguro de Saúde

🏥 Saúde

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ é uma presença no LinkedIn ou programa/escritório local associado ao Horizon Blue Cross Blue Shield de New Jersey (BCBSNJ). Com base no nome e no contexto, parece estar conectado às operações de seguro de saúde do Horizon BCBSNJ e ao alcance local ou envolvimento de membros/provedores na área de Wall, NJ. As informações disponíveis publicamente são limitadas e consistem principalmente na interface do site do LinkedIn em vez de um perfil da empresa, então essa descrição é conservadora e baseada na afiliação indicada pelo nome.

Descrição

• Perform assessments for PCA and MDC services using established guidelines to ensure appropriate levels of care and authorized services • Assess patients’ clinical needs against guidelines and benefit structures • Evaluate the necessity, appropriateness, and efficiency of services • Develop, coordinate, and assist with implementation of member services • Coordinate with patients, families, physicians, hospitals, and external customers throughout the continuum of care • Coordinate high-quality, cost-effective care using clinical practice guidelines • Monitor medical care activities and outcomes for appropriateness and effectiveness • Advocate for members and families across care settings • Refer members to MLTSS and educate members about SNP availability when appropriate • Document accurately and comprehensively according to practice standards and organizational policies • Communicate with multidisciplinary teams telephonically and/or in person • Evaluate care, solve problems, analyze variances, and participate in quality improvement • Complete NJ Choice Home Care Assessments for new MLTSS referrals • Assist with MLTSS case management and support MLTSS Care Management staff, including annual, 90-day, and post-hospital visits • Perform other duties assigned by management

🎯 Requisitos

• High School Diploma/GED required • Bachelor degree preferred, or relevant experience in lieu of degree • Minimum of two (2) years clinical experience preferred • Active unrestricted NJ RN License required • Proficiency with personal computers and Windows-based software, including MS Office (Word, Excel, PowerPoint) and Lotus Notes • Knowledge of intranet and internet applications preferred • Working knowledge of case/care management principles • Working knowledge of utilization management principles • Basic knowledge of health care contracts and benefit eligibility requirements preferred • Knowledge of hospital structures and payment systems preferred • Analytical, interpersonal, client relationship-building, decision-making, active listening, organization/planning, problem-solving, critical-thinking, teamwork, time-management, and written/oral communication skills • Bilingual skills preferred • Daily local travel required • Car with valid New Jersey State License and insurance required

🏖️ Benefícios

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement