RN I, PCA/MDC/DSNP

Job not on LinkedIn

🕒 July 27

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

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

💵 $70.5k - $94.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 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

🎯 Requirements

• 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

🏖️ Benefits

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