RN II, Care Manager

Emploi pas sur LinkedIn

🕒 il y a 13 jours

🦌 Connecticut, New Jersey, +2 états de plus – Distant

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

💵 $79 100 - $105 945 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 17%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Horizon Connect @ Wall BCBSNJ

Site WebLinkedInTous les Emplois

2 - 10 employés

⚕️ Assurance santé

🏥 Santé

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ est une présence sur LinkedIn ou un programme/bureau local associé à Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). D'après le nom et le contexte, il semble être lié aux opérations d'assurance santé de Horizon BCBSNJ et à son outreach local ou son engagement auprès des membres/fournisseurs dans la région de Wall, NJ. Les informations disponibles publiquement sont limitées et se concentrent principalement sur l'interface de LinkedIn plutôt qu'un profil d'entreprise, cette description est donc prudente et basée sur l'affiliation indiquée par le nom.

Description

• Perform RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care • Plan transitions to the continuum of care and develop member-centric plans of care • Outreach to high-risk members and engage members in preventative care opportunities and screenings • Assess members' clinical needs against established guidelines and standards • Facilitate responses to gaps in care and identified high-risk members • Evaluate the necessity, appropriateness, and efficiency of medical services and procedures • Develop, coordinate, and assist with implementation of individualized plans of care • Coordinate with members, families, physicians, hospitals, and external customers • Coordinate high-quality, cost-effective care across the continuum, including transitional care • Monitor medical care activities and outcomes for appropriateness and effectiveness • Advocate for members and families across care sites • Encourage participation and compliance in case/disease management programs • Document accurately and comprehensively according to standards and policies • Communicate with multidisciplinary teams telephonically and/or in person • Evaluate care, analyze variances, and participate in quality improvement programs • Mentor and train new RNs and other staff • Present clinical cases during audits conducted by external review organizations

🎯 Exigences

• Requires an associate's or bachelor's 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 • Requires a minimum of three (3) years' experience in the health care delivery system/industry • Experience with both acute and chronic conditions preferred • Experience with health care payer experience strongly preferred • Active Unrestricted RN License Required; NJ License Preferred • Requires a valid Driver's License and Insurance • Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook • Working knowledge of case/care/disease management principles • Working knowledge of utilization, case and/or disease management processes • Working knowledge of principles of utilization management • Basic knowledge of health care contracts and benefit eligibility requirements • Knowledge of hospital structures and payment systems • Bi-lingual proficiency preferred • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Avantages

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