RN, RN Nurse, Healthcare Nursing

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us.

We pride ourselves on our best‑in‑class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

This position is responsible for performing RN duties using established guidelines to ensure an appropriate level തീരുമാനം 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.

• 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 activitiesuei 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.

• Requires an associate‑s or bachelor‑s degree (or higher) in nursing and/or a health‑related field OR accredited diploma nursing school.
• Requires a minimum of two (2) years clinical experience.

RN’s are required to work a specified number of weekends and holidays to meet regulatory and accrediting body עציפ. Requirements may vary based on department’s business needs.

• Active Unrestricted NJ RN License Required.

• Proficiency in the use of personal computers and supporting software in a Windows‑based environment, including MS Office products (Word, Excel, PowerPoint, and Outlook) and knowledge 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.

• Analytical
• Compassion
• Interpersonal & Client Relationship Skills
• Judgment
• Listening
• Planning/Priority Setting
• Problem Solving
• Team Player
• Time Management
• Written/Oral Communication & Organizational Skills

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

$70,500 – $94,395

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration(article) 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.