Register
Recruit Create CV
Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Rn Case Manager - Remote | Wfh
Recruited by Get.It Recruit - Administrative 8 months ago Address San Antonio, TX, United States
Rn Case Manager - Healthy First Steps Program - Remote - Fl
Recruited by UnitedHealthcare 8 months ago Address , Gainesville, 32602
Rn To Np Transition Program
Recruited by Wellstar Health System 9 months ago Address , Atlanta, 30339
Case Manager Rn Jobs
Recruited by CVS Health 9 months ago Address , San Antonio, 78238 $58,760 - $125,840 a year
Telephonic Case Manager (Rn) - Tx Only
Recruited by Molina Healthcare 9 months ago Address , Dallas, Tx $26.41 - $51.49 an hour
Rn Case Manager Jobs
Recruited by HarmonyCares 9 months ago Address Irving, TX, United States
Pediatric Rn Friday 7:30A-5P Or Sat & Sun 9A-2P 78415
Recruited by Kids First Pediatric Homecare 9 months ago Address Corpus Christi, TX, United States
Rn Case Manager Jobs
Recruited by Amcare Pro Home Health 10 months ago Address Briarwood States, TX, United States
Pediatric Rn Sat & Sun 6A-6P 78216
Recruited by Kids First Pediatric Homecare 10 months ago Address San Antonio, TX, United States
Pediatric Rn Sun/Tues/Thurs 7P-7A 78245
Recruited by Kids First Pediatric Homecare 10 months ago Address San Antonio, TX, United States
Pediatric Rn 6P-6A 78023
Recruited by Kids First Pediatric Homecare 10 months ago Address Helotes, TX, United States
Pediatric Rn Friday 8Am-6P 78233
Recruited by Kids First Pediatric Homecare 10 months ago Address San Antonio, TX, United States
Pediatric Rn Fri- Sun 6P-6A 78245
Recruited by Kids First Pediatric Homecare 10 months ago Address San Antonio, TX, United States
Pediatric Rn Mon- Friday 6A-6P 78108
Recruited by Kids First Pediatric Homecare 10 months ago Address Cibolo, TX, United States
Travel Nurse Rn - Er/Trauma - $1,950 Per Week In Oklahoma
Recruited by TravelNurseSource 10 months ago Address Plano, TX, United States
Rn Specialist Complex Case Manager- Remote
Recruited by Blue Cross and Blue Shield of Minnesota 11 months ago Address , Eagan, Mn

Rn I - Maternity Case Manager

Company

Horizon Blue Cross Blue Shield of New Jersey
Address , Newark, 07105, Nj
Employment type FULL_TIME
Salary $67,100 - $89,880 a year
Expires 2023-10-04
Posted at 9 months ago
Job Description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
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.
  • Bilingual Spanish strongly preferred.
Responsibilities:
  • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
  • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
  • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
  • Documents accurately and comprehensively based on the standards of practice and current organization policies.
  • Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
  • Completes other assigned functions as requested by management.
  • Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
  • Coordinates and assists in implementation of plan for members.
  • 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.
  • Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
  • Encourages member participation and compliance in the case/disease management program efforts.
  • 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.
  • Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate 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.

Education/Experience:
  • Requires a minimum of two (2) years clinical experience.
  • Requires an associate-s or bachelor-s degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.
Utilization Management Only
  • RN’s are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards. Requirements may vary based on department’s business needs.
Additional licensing, certifications, registrations:
  • Active Unrestricted NJ RN License or active Compact License Required.

Knowledge:
  • Prefers working knowledge of case/care management principles.
  • Prefers basic knowledge of health care contracts and benefit eligibility requirements.
  • Prefers knowledge of hospital structures and payment systems.
  • Prefers working knowledge of principles of utilization management.
  • Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook) prefers knowledge in the use of intranet and internet applications.
Skills and Abilities:
  • Listening
  • Interpersonal & Client Relationship Skills
  • Time Management
  • Analytical
  • Compassion
  • Team Player
  • Judgment
  • Planning/Priority Setting
  • Problem Solving
  • Written/Oral Communication & Organizational Skills

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.
Salary Range:
$67,100 - $89,880
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:
  • Incentive Plans
  • Tuition Reimbursement
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Generous PTO
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.