RN I, PCA/MDC/DSNP

Job not on LinkedIn

🕒 July 27

🇺🇸 United States – Remote

💵 $70.5k - $94.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 49%

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 assessments for PCA and MDC services using established guidelines and assessments to authorize the appropriate level of care and services • Assess patients' clinical needs against guidelines and standards to ensure medically appropriate services aligned with benefit structures • Evaluate the necessity, appropriateness and efficiency of services • Develop, coordinate and assist in implementing services to meet member needs • Coordinate with patients, families, physicians, hospitals and other external customers regarding care appropriateness 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 across sites of service • Advocate for members and families to coordinate resource utilization and evaluate services • Refer members to MLTSS when appropriate and educate members about SNP availability • 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 • Complete NJ Choice Home Care Assessments for new MLTSS referrals • Assist with MLTSS Case Management as needed • Support MLTSS Care Management Staff with Annual Assessment, 90-day and/or Post Hospital visits • Evaluate care, solve problems, analyze variances and participate in quality improvement programs • Complete other functions and duties assigned by management

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • A minimum of two (2) years clinical experience is preferred • Active Unrestricted NJ RN License Required • Proficiency in personal computers and supporting software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes • Working knowledge of case/care management principles • Working knowledge of principles of utilization management • Basic knowledge of health care contracts and benefit eligibility requirements preferred • Knowledge of hospital structures and payment systems preferred • Analytical, interpersonal and client relationship-building, decision-making, active listening, organization/planning/priority-setting, problem-solving/critical-thinking, teamwork, time-management, and written/oral communication skills • Bi-lingual preferred • Daily local travel required • Requires a car with valid New Jersey State License and Insurance • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

🏖️ Benefits

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