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Horizon Blue Cross Blue Shield of New JerseyPosted 1 week ago

RN II (Field Based - Middlesex County)

$79,100–$105,945 year

On-siteHopewell, New Jersey, United States

Full TimeLicense Or CertificationLarge

Job Summary

Assess members' clinical needs against established guidelines to ensure medically appropriate services and evaluate the necessity, appropriateness, and efficiency of care provided. Develop and coordinate individualized plans of care while monitoring medical activities and outcomes across all sites of service. Advocate for members among various sites to coordinate resource utilization and encourage participation in the program. Document accurately based on standards of practice and interact with multidisciplinary teams to ensure continuity from diagnosis to outcome. Complete assigned functions as requested by management. This field-based role requires daily local travel and a valid New Jersey driver's license.

Required Qualifications

  • High School Diploma/GED
  • Active Unrestricted NJ RN License
  • Minimum of two (2) years clinical experience
  • 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
  • Working knowledge of case/care management principles
  • Working knowledge of principles of utilization management
  • Bi-lingual
  • Valid New Jersey State License
  • Valid car insurance

Desired Qualifications

  • Bachelor degree
  • Relevant experience in lieu of degree
  • Knowledge in the use of intranet and internet applications
  • Basic knowledge of health care contracts and benefit eligibility requirements
  • Knowledge of hospital structures and payment systems

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