RN II, Field (Field Based - Cumberland County)

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

1d•$79,100 - $105,945•Onsite

About The Position

This field-based position is responsible for assessing members using established guidelines to ensure an appropriate level of care and to develop member-centered plans of care. The role coordinates care across the continuum, evaluates the appropriateness and efficiency of services, monitors member care and outcomes, and advocates for members and their families. Daily local travel is required. The employee must have a car, a valid New Jersey driver's license, and insurance. Horizon Blue Cross Blue Shield of New Jersey serves 3.5 million members and describes itself as a New Jersey health solutions leader focused on improving health care quality, affordability, and member experience. The organization emphasizes an innovative and inclusive environment, collaboration, and meaningful work that improves lives. The stated salary range is $79,100–$105,945. Horizon also offers a comprehensive compensation and benefits package. Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Requirements

Associate's or bachelor's degree or higher in nursing, or graduation from an accredited diploma nursing school.
At least two years of clinical experience.
Active, unrestricted New Jersey RN license.
Proficiency using personal computers and Windows-based software, including MS Office products (Word, Excel, and PowerPoint) and Lotus Notes.
Working knowledge of case/care management principles.
Working knowledge of utilization management principles.
Analytical, compassionate, and able to build interpersonal and client relationships.
Sound decision-making, active listening, organization, planning, and priority-setting abilities.
Problem-solving and critical-thinking skills.
Ability to work as a team player and manage time effectively.
Written and oral communication skills.
Daily local travel is required; must have a car, valid New Jersey driver's license, and insurance.
Must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

Nice To Haves

Knowledge of intranet and internet applications.
Basic knowledge of health care contracts and benefit eligibility requirements.
Knowledge of hospital structures and payment systems.
Bilingual communication skills.

Responsibilities

Assess members' clinical needs against established guidelines or standards to ensure services are medically appropriate.
Evaluate the necessity, appropriateness, and efficiency of services provided.
Develop, coordinate, and assist with implementation of individualized member plans of care.
Coordinate with patients, families, physicians, hospitals, and other external customers regarding appropriate care from diagnosis through outcome.
Coordinate high-quality, cost-effective care supported by the plan's clinical practice guidelines across the continuum of care.
Monitor members' medical care activities, regardless of service location, and evaluate outcomes for appropriateness and effectiveness.
Advocate for members and families across care settings to coordinate resource utilization and evaluate services.
Encourage member participation and compliance in the program.
Document accurately and comprehensively in accordance with standards of practice and current organizational policies.
Communicate with multidisciplinary teams by telephone and/or in person to support continuity and efficiency throughout the continuum of care.
Apply fiscal accountability and consider its impact on resource utilization and self-care outcomes.
Evaluate care by problem-solving, analyzing variances, and participating in the quality improvement program to enhance member outcomes.
Complete other functions assigned by management.