RN II, Field (Middlesex County)

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

2d•$79,100 - $105,945•Onsite

About The Position

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care.

Requirements

High School Diploma/GED required.
Requires a minimum of two (2) years clinical experience.
Active Unrestricted NJ RN License Required.
Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel,PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
Analytical
Compassionate
Interpersonal & Client Relationship Building Skills
Sound Decision Making
Active Listening
Organization/Planning/Priority Setting
Problem Solving/Critical Thinking
Team Player
Time Management
Written/Oral Communication Skills
This is a field based position, daily local travel is required.
Requires a car with valid New Jersey State License and Insurance.

Nice To Haves

Bachelor's degree preferred or relevant experience in lieu of degree.
Working knowledge of case/care management principles.
Working knowledge of principles of utilization management.
Prefers basic knowledge of health care contracts and benefit eligibility requirements.
Prefers knowledge of hospital structures and payment systems.
Bi-lingual preferred

Responsibilities

Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs.
Evaluates the necessity, appropriateness and efficiency of services provided.
Develops, coordinates and assists in implementation of members- individualized plan of care.
Coordinates with patient, 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.
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 program.
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.
Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
Completes other assigned functions as requested by management.