RN II – Oncology Case Manager

Job not on LinkedIn

🔥 0 minutes ago

🦌 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 18%

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 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 from diagnosis to 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 and coordinate resource utilization • 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 staff • Act as a subject matter expert for projects, committees and user acceptance testing for 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 • Build trusting relationships using Motivational Interviewing techniques • Explain employer-sponsored benefits, claims, care coordination and complex needs in plain language • Advocate throughout members’ healthcare journeys and focus on whole-person support • Work an 8- or 10-hour workday Monday through Friday, varying between 8am and 11pm

🎯 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 • Proficiency in personal computers and Windows-based software, 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 • Knowledge of mentoring operations for utilization/case/disease management • Ability to work specified weekends and holidays for Utilization Management roles, as required by department needs • 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