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RN II - Case Management
Horizon Blue Cross Blue Shield of New Jersey
Hopewell, New Jersey, United States
Full Time
Remote
Mid
USD 79,100 – 105,945
High School
Healthcare
Healthcare Life Sciences
Posted 3 days ago
Job summary
The RN II - Case Management role involves assessing patient needs, coordinating care, ensuring appropriate medical services, advocating for members, and serving as a mentor for new RNs. The position requires clinical assessment, care coordination, communication, and knowledge of health care systems within a health insurance setting.
Responsibilities
Assess members’ clinical needs and the appropriateness of care, coordinate services and transitions across the continuum, and advocate for members while monitoring outcomes and resource use. Document care, collaborate with multidisciplinary teams, contribute to quality improvement and committees, and mentor staff as needed.
Qualifications
care coordination
clinical assessment
communication skills
disease management
hospital systems knowledge
Medicare/Medicaid knowledge
motivational interviewing
patient advocacy
software proficiency
utilization management
Requires an active, unrestricted New Jersey RN license or active compact license, at least two years of clinical experience, and at least two years of health care payer experience; a high school diploma or GED is required, and a bachelor’s degree is preferred or relevant experience may substitute. Candidates should know case, care, disease, and utilization management processes, hospital structures, payment systems, contracts, and benefits; CCM certification is preferred for Clinical Advocate roles.
English
Benefits
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Retirement Plans
- Paid Time Off
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Insurance
- Location
- Hopewell, New Jersey, United States
- Website
- horizonblue.com
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Role
RN II - Case Management
Company
Horizon Blue Cross Blue Shield of New Jersey
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