RN II – Oncology Case Manager

Job not on LinkedIn

🕒 August 28

🦌 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 38%

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 • Plan transitions to the continuum of care • Perform assigned care management duties • Assess patients’ clinical needs against 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 as appropriate • Coordinate with patients, families, physicians, hospitals and external customers from diagnosis through outcome • Coordinate high-quality, cost-effective care across the continuum • Monitor medical care activities and outcomes for appropriateness and effectiveness • Advocate for members and families across care sites • 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 • Evaluate care, analyze variances and participate in quality improvement programs • Mentor and train new RNs and other staff • Serve as subject matter expert for projects and committees • Assume leadership activities in the team lead’s absence • Represent clinical teams and present reports at committee meetings • Serve as subject matter expert for user acceptance testing of the medical management system • Outreach to members requiring Clinical Advocate services • Apply critical thinking and clinical expertise to maximize outcomes • Build trusting relationships using Motivational Interviewing techniques • Explain employer-sponsored benefits, claims and care coordination in plain language • Advocate throughout members’ healthcare journeys and coordinate resources • 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 • Minimum of two (2) years clinical experience • Minimum of two (2) years’ experience with health care payer experience • Active Unrestricted NJ RN License or active Compact License Required • CCM certification preferred for Horizon Clinical Advocate roles • Proficient in personal computers and supporting software in a Windows-based environment, including MS Office (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 on utilization/case/disease management operations • Ability to work specified weekends and holidays for Utilization Management roles, as required by department needs • Ability to work an 8- or 10-hour workday Monday through Friday, varying between 8am and 11pm • Ability to understand and communicate members benefits, claims and coordination • Experience in active listening and motivational interviewing strongly preferred • Excellent communication and organizational skills • Strong analytical, critical thinking and interpersonal skills • Ability to work in a collaborative team environment

🏖️ Benefits

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