RN I
Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, United States
About the Role
This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.
What You'll Do
Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
Coordinates and assists in implementation of plan for members.
Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiates fees for such services as appropriate. 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.
Encourages member participation and compliance in the case/disease management program efforts.
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.
What You Bring
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; knowledge in the use of intranet and internet applications.
Working knowledge of case/care management principles.
Working knowledge of principles of utilization management.
Basic knowledge of health care contracts and benefit eligibility requirements.
Knowledge of hospital structures and payment systems.
Skills/Abilities
Analytical
Compassion
Interpersonal & Client Relationship Skills
Judgment
Listening
Planning/Priority Setting
Problem Solving
Team Player
Time Management
Written/Oral Communication & Organizational Skills
Education
Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field or accredited diploma nursing school.
Experience
Requires a minimum of two (2) years clinical experience.
Additional licensing, certifications, registrations
Requires an active unrestricted New Jersey Registered Nurse License.
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Salary Range
$70,500 - $94,395
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.
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This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.
What You'll Do
Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
Coordinates and assists in implementation of plan for members.
Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiates fees for such services as appropriate. 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.
Encourages member participation and compliance in the case/disease management program efforts.
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.
What You Bring
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; knowledge in the use of intranet and internet applications.
Working knowledge of case/care management principles.
Working knowledge of principles of utilization management.
Basic knowledge of health care contracts and benefit eligibility requirements.
Knowledge of hospital structures and payment systems.
Skills/Abilities
Analytical
Compassion
Interpersonal & Client Relationship Skills
Judgment
Listening
Planning/Priority Setting
Problem Solving
Team Player
Time Management
Written/Oral Communication & Organizational Skills
Education
Requires an associate's or bachelor's degree (or higher) in nursing and/or a health related field or accredited diploma nursing school.
Experience
Requires a minimum of two (2) years clinical experience.
Additional licensing, certifications, registrations
Requires an active unrestricted New Jersey Registered Nurse License.
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Salary Range
$70,500 - $94,395
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.
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