Serves as a mentor/trainer to new RN's and other staff as needed. Positions involving ASO accounts may require some travel for on-site availability. What You'll Do * Assesses member's clinical need ...
Serves as a mentor/trainer to new RN's and other staff as needed. Positions involving ASO accounts may require some travel for on-site availability. What You'll Do * Assesses member's clinical need ...
At AMC Health, we are transforming healthcare through advanced remote patient monitoring and ... Collaborate with clinical management, RN Care Managers, providers, and interdisciplinary care teams ...
At AMC Health, we are transforming healthcare through advanced remote patient monitoring and ... Collaborate with clinical management, RN Care Managers, providers, and interdisciplinary care teams ...
Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and committees as needed. What You'll Do * Assesses patient's clinical need against ...
Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and committees as needed. What You'll Do * Assesses patient's clinical need against ...
Remote Healthcare Recruiter (General Healthcare - Nationwide)
Hoboken, NJ · Remote
$70K - $80K/yr
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Remote Healthcare Recruiter (General Healthcare - Nationwide)
Hoboken, NJ · Remote
$70K - $80K/yr
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Remote Certified Coder
Atlantic City, NJ · Remote
$22.50 - $31/hr
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Atlantic City, NJ · Remote
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hackensack, NJ · Remote
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hackensack, NJ · Remote
$66K - $142K/yr
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hoboken, NJ · Remote
$66K - $142K/yr
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hoboken, NJ · Remote
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hackensack, NJ · Remote
$66K - $142K/yr
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hackensack, NJ · Remote
$66K - $142K/yr
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Case Manager Registered Nurse - Field in Bergen/Hudson Counties
Hoboken, NJ · Remote
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Hoboken, NJ · Remote
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Trenton, NJ · Remote
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Trenton, NJ · Remote
$66K - $142K/yr
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East Orange, NJ · Remote
$66K - $142K/yr
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$66K - $142K/yr
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East Orange, NJ · Remote
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East Brunswick, NJ · Remote
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East Brunswick, NJ · Remote
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Lumberton, NJ · Remote
$66K - $142K/yr
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Lumberton, NJ · Remote
$66K - $142K/yr
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Lawrence Township, NJ · Remote
$66K - $142K/yr
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Case Manager Registered Nurse - Field in Middlesex County NJ
Lawrence Township, NJ · Remote
$66K - $142K/yr
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Atlantic City, NJ · On-site +1
$22.50 - $31/hr
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$79K - $100K/yr
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Marlton, NJ · Remote
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Marlton, NJ · Remote
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Marlton, NJ · Remote
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(Hybrid) New Jersey Licensed - Outpatient/Telehealth Psychiatric Mental Health Nurse Practitioner...
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Montclair, NJ · On-site +1
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Four days on-site in New Brunswick, NJ and one day remote weekly. * Salary Range: $150,000 to $175 ... Active RN license in the state of New Jersey. * BSN degree required. Master's or Doctoral degree is ...
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Remote Rn Poison Control information
What are Remote RN Poison Control nurses?
What are some common challenges Remote RN Poison Control nurses face, and how can they effectively manage them?
What are the key skills and qualifications needed to thrive as a Remote RN Poison Control, and why are they important?

RN II, Primary Nurse Care (Case Manager-REMOTE)
Horizon Blue Cross Blue Shield of New JerseyHopewell, NJ • On-site, Remote
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 9 days ago
Horizon Blue Cross Blue Shield of New Jersey rating
8.0
Based on 22 frontline employees who took The Breakroom Quiz
146th of 260 rated insurance
Job description
About the Role
This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportunities & screenings when possible. This position will perform duties and types of care management as assigned by management. Serves as a mentor/trainer to new RN's and other staff as needed. Positions involving ASO accounts may require some travel for on-site availability.
What You'll Do
- Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure.
- Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider.
- Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs.
- Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness.
- Coordinates with members, 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 including transitional care.
- Monitors member'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.
- Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
- Serves as mentor/trainer to new RN's and other staff as needed
- Presents clinical cases during audits conducted by external review organizations.
- Performs other duties as assigned by management.
What You Bring
Education/Experience:
- High School Diploma/GED required.
- Bachelor degree preferred or relevant experience in lieu of degree.
- Requires a minimum of two (2) years clinical experience. Experience with both acute and chronic conditions preferred.
- Requires a minimum of three (3) years' experience in the health care delivery system/industry.
- Experience with health care payer experience strongly preferred.
Additional licensing, certifications, registrations:
- Active Unrestricted RN License Required; NJ License required and/or Compact License.
- Requires a valid Driver's License and Insurance.
Knowledge:
- Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook. Prefers knowledge in the use of intranet and internet applications.
- Requires working knowledge of case/care/disease management principles.
- Requires working knowledge of operations of utilization, case and/or disease management processes.
- Requires working knowledge of principles of utilization management.
- Requires basic knowledge of health care contracts and benefit eligibility requirements.
- Requires knowledge of hospital structures and payment systems.
- Prefers understanding of fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
Skills and Abilities:
- Bi-lingual proficiency preferred.
- Adaptability/Flexibility.
- Analytical.
- Compassion.
- Information/Knowledge Sharing.
- Interpersonal & Client Relationship.
- Sound decision making.
- Active listening.
- Organization Planning/Priority Setting.
- Problem Solving/Critical Thinking.
- Team Player.
- Time Management.
- Written/Oral Communications.
Travel:
- Travel primarily within State of NJ may be required. Occasional travel in the tri-state area may also be required.
Why Horizon?
At Horizon, you'll do meaningful work that directly improves lives-while being supported by a mission-driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we'd love to hear from you!
Salary Range:
$79,100 - $105,945
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:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Disclaimer:
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.
What Horizon Blue Cross Blue Shield of New Jersey employees say
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About Horizon Blue Cross Blue Shield of New Jersey
Sourced by ZipRecruiter
Industry
Insurance services
Company size
5,001 - 10,000 Employees
Headquarters location
Newark, NJ, US
Year founded
1932