RN II – Primary Nurse Care

Job not on LinkedIn

🔥 16 hours 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

👻 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 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 members in preventative care opportunities and screenings. • Assess members’ clinical needs against established guidelines and benefit structures. • Facilitate responses to gaps in care and direct high-risk members to appropriate care settings. • Evaluate the necessity, appropriateness, and efficiency of medical services and procedures for acute and chronic needs. • Develop, coordinate, and assist in implementing individualized plans of care and identify barriers to self-management and optimal wellness. • Coordinate with members, families, physicians, hospitals, and external customers regarding appropriateness of care. • Coordinate high-quality, cost-effective care across the continuum, including transitional care. • Monitor members’ medical care activities and outcomes for appropriateness and effectiveness. • Advocate for members and families across care sites to coordinate resource utilization and evaluate services. • Encourage member participation and compliance in case/disease management programs. • Document accurately and comprehensively according to 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 as needed. • Present clinical cases during audits conducted by external review organizations. • Perform other duties as assigned by management. • Positions involving ASO accounts may require some travel for on-site availability.

🎯 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. • Experience with both acute and chronic conditions preferred. • Experience with health care payer experience strongly preferred. • Active Unrestricted RN License Required; NJ License required and/or Compact License. • Requires a valid Driver's License and Insurance. • Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and 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. • Bi-lingual proficiency preferred. • Skills in adaptability/flexibility, analysis, compassion, information/knowledge sharing, interpersonal and client relationship management, sound decision making, active listening, organization planning/priority setting, problem solving/critical thinking, teamwork, time management, and written/oral communications.

🏖️ Benefits

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