RN II, Care Manager – Oncology

Vaga não está no LinkedIn

🕒 6 dias atrás

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

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

💵 $79.100 - $105.945 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

🚫👨‍🎓 Sem graduação necessária

👻 Score fantasma 15%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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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 RN duties using established guidelines to ensure appropriate level of care and plan transitions to the continuum of care. • Assess patients’ clinical needs against established guidelines and standards for medically appropriate inpatient care and length of stay. • Evaluate the necessity, appropriateness, and efficiency of medical services and procedures. • Coordinate and assist with implementation of member care plans. • Monitor and coordinate out-of-network and out-of-area services and negotiate fees when appropriate. • Coordinate with patients, families, physicians, hospitals, and external customers regarding appropriateness of care from diagnosis to outcome. • Coordinate high-quality, cost-effective care across the continuum using clinical practice guidelines. • Monitor medical care activities and outcomes for appropriateness and effectiveness. • Advocate for members and families across care sites to coordinate resource utilization and evaluate services. • Encourage member participation and compliance in case/disease management programs. • Document accurately and comprehensively according to practice standards and organizational policies. • Communicate with multidisciplinary teams telephonically and/or in person to support continuity and efficiency. • Evaluate care, analyze variances, and participate in quality improvement initiatives. • Mentor and train new RNs and other staff. • Serve as subject matter expert for projects and user acceptance testing of the medical management system. • Assume leadership activities in the team lead’s absence. • Represent clinical teams and present reports at committee meetings. • Outreach to members needing Clinical Advocate services. • Apply critical thinking and clinical expertise to maximize outcomes in a fast-paced environment. • Build trusting relationships using Motivational Interviewing techniques. • Explain ASO client employer-sponsored benefits, claims, care coordination, and complex needs in plain language. • Advocate throughout members’ healthcare journeys and focus on whole-person support addressing physical, mental, and emotional well-being.

🎯 Requisitos

• High School Diploma/GED required. • Bachelor degree preferred or relevant experience in lieu of degree. • Requires a minimum of two (2) years clinical experience. • Requires minimum of two (2) years’ experience with health care payer experience. • Active Unrestricted NJ RN License or active Compact License Required. • CCM certification preferred. • Proficient in personal computers and supporting software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint and Outlook). • Knowledge of intranet and internet applications. • Knowledge of hospital structures and payment systems. • Working knowledge of case/care/disease management principles. • Working knowledge of utilization, case and/or disease management processes. • Knowledge of health care contracts and benefit eligibility requirements. • Mentoring knowledge of utilization/case/disease management operations. • Ability to work a specified number of weekends and holidays, as required by department business needs. • Ability to work an 8- or 10-hour workday Monday through Friday varying between 8am and 11pm. • Excellent communication and organizational skills and a high tolerance for ambiguity. • Ability to understand and communicate members’ benefits, claims and coordination. • Ability to work in a collaborative team environment. • Strong analytical, critical thinking and interpersonal skills. • Exceptional multi-channel communication and interpersonal skills, including ability to explain complex concepts clearly with compassion.

🏖️ Benefícios

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