RN II, Primary Nurse Care – Case Manager

Job not on LinkedIn

🔥 7 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

🟡 Mid-level

🟠 Senior

👔 Manager

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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 for the Primary Nurse population using established guidelines to ensure appropriate level of care • Plan transitions to the continuum of care and develop member-centric plans of care • Outreach to high-risk members and engage them in preventative care opportunities and screenings • Assess members' clinical needs against established guidelines and benefit structures • Facilitate responses to gaps in care and coordinate annual wellness visits with treating providers • Evaluate the necessity, appropriateness, and efficiency of acute and chronic medical services and procedures • Develop, coordinate, and assist with implementation of individualized member care plans • Coordinate with members, families, physicians, hospitals, and external customers across the continuum of care • 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 organization 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 • Present clinical cases during audits conducted by external review organizations • 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 years of clinical experience • Minimum of three years' experience in the health care delivery system/industry • Experience with both acute and chronic conditions preferred • Health care payer experience strongly preferred • Active unrestricted RN license required • NJ license and/or Compact License required • Valid driver's license and insurance required • Proficiency with personal computers and Windows-based software, including MS Office (Word, Excel, PowerPoint) and Microsoft Outlook • Working knowledge of case/care/disease management principles • Working knowledge of utilization, case, and/or disease management processes • Working knowledge of utilization management principles • Basic knowledge of health care contracts and benefit eligibility requirements • Knowledge of hospital structures and payment systems • Bilingual proficiency preferred • Ability to travel primarily within New Jersey, with occasional travel in the tri-state area

🏖️ Benefits

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