RN I, PCA/MDC/DSNP (Field RN - Camden County)

RN Assessor

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About the Role

The RN Assessor plays a vital, member-facing role within Camden County, with a primary focus on Camden City and surrounding areas including Pensauken and Cherry Hill. This position is responsible for conducting in-home assessments for individuals requesting services such as Personal Preference Programs (PPP), medical daycare (adult and pediatric), and personal assistance programs. In this highly autonomous role, the RN Assessor manages their own schedule to meet a required 7-day turnaround for evaluations, completing approximately 1416 member assessments per week. Assessments are conducted primarily in members' homes and involve evaluating Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), including mobility, bathing, toileting, hygiene, meal preparation, and household tasks. These evaluations require both observation and interview-based data collection to determine members' functional needs and level of support. The role is approximately 60% field-based and 40% remote, with administrative responsibilities including documentation, authorization completion, provider coordination, and scheduling follow-up visits. Based on assessment outcomes, the RN Assessor may also connect members to case management or long-term support services as appropriate. This position is ideal for a self-directed, organized RN who is comfortable working independently in the field while maintaining strong clinical judgment and documentation skills.

What You'll Do

• Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs and aligned with benefit structure.
• Evaluates the necessity, appropriateness and efficiency of service provided.
• Develops, coordinates and assists in implementation of services to meet the needs of the members.
• 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 patient'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.
• Refers members to MLTSS when appropriate.
• Educates members on the availability of DSNP if appropriate.
• 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.
• Performs duties as assigned by management.

What You Bring

Qualifications:

• Requires an associates or bachelors degree (or higher) in nursing and/OR accredited diploma nursing school.
• A minimum of two (2) years clinical experience is preferred

Additional licensing, certifications, registrations:

• Active Unrestricted NJ RN License Required.

Knowledge:

• 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.
• 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

Skills and Abilities:

• 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 (Bi-lingual preferred)

Travel:

• This is a field based position, daily local travel is required.
• Requires a car with valid New Jersey State License and Insurance

Why Horizon?

At Horizon, you'll do meaningful work that directly improves liveswhile being supported by a mission?driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!

Salary Range: $70,500 - $94,395

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

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

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Horizon Blue Cross Blue Shield of New Jersey