RN II – Primary Nurse Care

Job not on LinkedIn

🔥 2 hours ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $79.1k - $105.9k / 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

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure. • Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider. • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs. • Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness. • Coordinates with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care including transitional care. • Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Encourages member participation and compliance in the case/disease management program efforts. • Documents accurately and comprehensively based on the standards of practice and current organization policies. • Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires a minimum of two (2) years clinical experience • Requires a minimum of three (3) years' experience in the health care delivery system/industry • Active Unrestricted RN License Required; NJ License required and/or Compact License • Valid Driver's License and Insurance • Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook • Requires working knowledge of case/care/disease management principles • Requires working knowledge of operations of utilization, case and/or disease management processes • Requires working knowledge of principles of utilization management • Requires basic knowledge of health care contracts and benefit eligibility requirements • Requires knowledge of hospital structures and payment systems

🏖️ Benefits

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