This job is closed
Applications are no longer available for this announcement. Explore current related opportunities below.
Job description
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 members' 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 the member/family among various sites to coordinate resource utilization and evaluation of services.
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 and efficiency in care management.
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 healthcare quality, affordability, and member experience.
#J-18808-Ljbffr
Worksite address
hopewell, NJ, 08525, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.