RN- Health Care (Full-Time

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

Highlights Pay: $79,100 - $105,945/year

Location: Hopewell, NJ

Schedule: Full-time

What You'll Do Assess member's clinical need against established guidelines to ensure medically appropriate services.

Evaluate the necessity, appropriateness, and efficiency of services provided.

Develop, coordinate, and assist in the implementation of individualized plans of care.

Coordinate with patients, families, physicians, hospitals, and other external customers regarding care appropriateness.

Monitor member's medical care activities and outcomes for appropriateness and effectiveness.

Advocate for members/families among various sites to coordinate resource utilization.

Encourage member participation and compliance in the program.

Document accurately and comprehensively based on standards of practice and organization policies.

Interact and communicate with multidisciplinary teams to ensure continuity of care.

Evaluate care by problem-solving, analyzing variances, and participating in quality improvement programs.

Requirements Education:

High School Diploma/GED required

Bachelor degree preferred or relevant experience in lieu of degree

Experience:

Minimum of two (2) years clinical experience required

Licenses & Certifications:

Active Unrestricted NJ RN License required

Benefits Comprehensive health benefits (Medical/Dental/Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

About Horizon Blue Cross Blue Shield NJ Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health. For over 90 years, they have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience.

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