RN II, Field (Field Based - Cumberland County)

Horizon Healthcare Services•Hopewell, NJ

12d•Onsite

About The Position

This field-based position performs assessments of members using established guidelines to determine the appropriate level of care and develop member-centered plans of care. The role evaluates medical necessity, appropriateness, and efficiency of services; coordinates care across the continuum; monitors member care and outcomes; and advocates for members and families. It also documents care according to applicable standards and policies, supports quality improvement, and completes other functions assigned by management. Daily local travel is required, and the employee must have a car, a valid New Jersey driver's license, and insurance.

Requirements

Associate's or bachelor's degree or higher in nursing, and/or graduation from an accredited diploma nursing school.
At least two years of clinical experience.
Active, unrestricted New Jersey RN license.
Proficiency with personal computers and supporting software in a Windows-based environment, including Microsoft Word, Excel, PowerPoint, and Lotus Notes.
Working knowledge of case/care management principles.
Working knowledge of utilization management principles.
Analytical, compassionate, interpersonal, client relationship-building, decision-making, active listening, organization, planning, prioritization, problem-solving, critical-thinking, teamwork, time-management, and written and oral communication skills.
Ability to travel locally daily; must have a car, valid New Jersey state 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 and standards to ensure services are medically appropriate.
Evaluate the necessity, appropriateness, and efficiency of services provided.
Develop, coordinate, and assist with implementing 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 using the plan's clinical practice guidelines across the continuum of care.
Monitor members' medical care activities and outcomes across sites of service for appropriateness and effectiveness.
Advocate for members and families across care sites to coordinate resource use and evaluate services.
Encourage member participation and compliance in the program.
Document accurately and comprehensively according to practice standards and current organizational policies.
Communicate and collaborate with multidisciplinary teams by telephone and/or in person to promote continuity and efficiency of care.
Understand fiscal accountability and its impact on resource utilization and self-care outcomes.
Evaluate care, solve problems, analyze variances, and participate in quality improvement to enhance member outcomes.
Complete other assigned functions as requested by management.
Travel locally each day to perform field-based work.