RN II, Care Manager – Oncology

Job not on LinkedIn

🕒 August 27

🦌 Connecticut, New Jersey, +2 more states – Remote

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

💵 $79.1k - $105.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

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