RN II, Commercial Risk Adjustment
or drop it. There's no job ID in the text. Also remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The text includes a disclaimer about Horizon BCBSNJ employees must live in NJ etc., and EEO statement. Those should be removed. Also "Why Horizon?" section includes mission statement; we can keep as Benefits? Actually "Why Horizon?" includes description of meaningful work, mission-driven organization, etc. It also includes benefits list after that. We'll treat "Why Horizon?" as Benefits section? But we have separate Benefits heading. The posting includes "Why Horizon?" then bullet list of benefits. We'll create a Benefits section with that list. Also we have Salary Range section. We need to use
for section headings. Use - for any list of duties/requirements/benefits, and
for prose.
We must include a section ONLY when posting has real, specific content for it. So we need sections: About the role (we have a paragraph), Responsibilities (What You'll Do), Requirements (Education/Experience etc.), Benefits (Why Horizon? + benefits list), Pay (Salary Range), Schedule (Travel). Ensure we don't create sections with filler like "commensurate with experience". Not present.
We must preserve ALL substantive information; do not invent or summarize away detail. So we need to keep all details from each section.
We need to format as HTML fragment only, no or . Use headings
. For each section, after heading we put content: either
for prose, or
- for lists.
We need to parse the content.
Let's extract sections.
Original text:
"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. About The Role This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high risk members on an annual basis and will work to engage these members in preventative care opportunities & screenings, including opportunities in retail settings if possible. This position is responsible for performing RN duties for members in commercially risk adjusted products , 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. When appropriate, there will be responsibility for ensuring members are engaged for annual wellness visits. This position will leverage analytical insights from RAM to create clinical strategies that drive encounters for high-risk members that support commercial risk adjustment initiatives. This position serves as a mentor/trainer to new RN's and other staff as needed. Positions involving the commercially risk adjusted population may require travel."
Then "What You'll Do" list of duties (many sentences each starting with a verb). We'll treat as list.
Then "Education/Experience What You Bring" includes bullet-like sentences but not formatted as list. We need to turn into list.
Then "Additional Licensing, Certifications, Registrations" etc.
Then "Knowledge" etc.
Then "Skills And Abilities" list.
Then "Travel Up to 25%Travel primarily within State of NJ may be required. Occasional travel in the tri-state areas may also be required.Positions for the exchange population are field based and will require travel."
Then "Why Horizon?" paragraph.
Then benefits list: "Comprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition Reimbursement"
Then disclaimer etc to remove.
We need to ensure we don't duplicate content. For Requirements, we should combine Education/Experience, Additional Licensing..., Knowledge, Skills And Abilities into one Requirements section? The instruction: Prefer a few substantive sections over many thin ones. So we could combine all requirement-related info into a single Requirements section with sublists? But we must use
- for any list. Could have multiple
inside the section. Or we could have separate headings for each subcategory? But they said prefer few substantive sections over many thin ones. So maybe one Requirements section containing multiple groups each preceded by a heading? But we cannot use headings inside section besides the main
. We could use
to label subparts like "Education/Experience:" then a
. That's acceptable.
Thus structure:
About the Role
... (the paragraph about role)
Responsibilities
- ...
...
Requirements
Education/Experience:
- High School Diploma/GED required.
- Bachelor degree in Nursing preferred or relevant experience in lieu of degree.
- Requires a minimum of two (2) years clinical experience.
- Prefer experience with the elderly, frail and those with chronic conditions.
- Requires a minimum of three (3) years' experience in the health care delivery system/industry.
- Requires a minimum of two (2) years' experience with health care payer experience.
Additional Licensing, Certifications, Registrations:
- Active Unrestricted RN License Required; NJ License Preferred.
- 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, 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
Benefits
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!
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Pay
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.
Schedule
Travel Up to 25% Travel primarily within State of NJ may be required. Occasional travel in the tri-state areas may also be required. Positions for the exchange population are field based and will require travel.
We need to ensure we removed boilerplate: the disclaimer about Horizon BCBSNJ employees must live in NJ etc., and EEO statement. Also remove any duplicated lines. The "About The Role" paragraph we included. Ensure we didn't include any application instructions (none present). Also remove any "Why Horizon?" duplicated? We kept the paragraph.
Check for any leftover boilerplate: The text after benefits includes disclaimer and EEO. We removed.
Now ensure we didn't miss any substantive info: The "About The Role" paragraph we captured fully? Let's verify original: "About The Role This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high risk members on an annual basis and will work to engage these members in preventative care opportunities & screenings, including opportunities in retail settings if possible. This position is responsible for performing RN duties for members in commercially risk adjusted products , 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. When appropriate, there will be responsibility for ensuring members are engaged for annual wellness visits. This position will leverage analytical insights from RAM to create clinical strategies that drive encounters for high-risk members that support commercial risk adjustment initiatives. This position serves as a mentor/trainer to new RN's and other staff as needed. Positions involving the commercially risk adjusted population may require travel."
We included that as paragraph. Good.
Now "What You'll Do" list: Let's extract each bullet:
- Facilitates the navigation of high risk members to appropriate settings of care for annual wellness visits, including outreach to members, providers and retail pharmacies.
- Coordinates transition of member from RAM RN to care management RN based qualification for CM program and member commitment to participation.
- Encourages member participation and compliance in the case/disease management program efforts
- Works closely with RAM Business Analyst and Manager to engage at-risk members in commercially risk adjusted markets.
- Deploys clinical engagement strategy to integrate clinical insights from multiple information sources, including RAM, member outreach calls, or retail pharmacies.
- Performs ad-hoc clinical outreach strategy development to highest risk members to support commercial risk adjustment tactics.
- Interprets analytical reports as developed by the RAM team to deploy clinical outreach strategy.
- Develops & expands member outreach initiatives to case / disease management eligible members, including driving potential physician or pharmacy visits.
- Assesses member's clinical need against established guidelines and/or
for prose. We must include a section ONLY when posting has real, specific content for it. So we need sections: About the role (we have a paragraph), Responsibilities (What You'll Do), Requirements (Education/Experience etc.), Benefits (Why Horizon? + benefits list), Pay (Salary Range), Schedule (Travel). Ensure we don't create sections with filler like "commensurate with experience". Not present. We must preserve ALL substantive information; do not invent or summarize away detail. So we need to keep all details from each section. We need to format as HTML fragment only, no or . Use headings
. For each section, after heading we put content: either
for prose, or
- for lists.
We need to parse the content.
Let's extract sections.
Original text:
"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. About The Role This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high risk members on an annual basis and will work to engage these members in preventative care opportunities & screenings, including opportunities in retail settings if possible. This position is responsible for performing RN duties for members in commercially risk adjusted products , 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. When appropriate, there will be responsibility for ensuring members are engaged for annual wellness visits. This position will leverage analytical insights from RAM to create clinical strategies that drive encounters for high-risk members that support commercial risk adjustment initiatives. This position serves as a mentor/trainer to new RN's and other staff as needed. Positions involving the commercially risk adjusted population may require travel."
Then "What You'll Do" list of duties (many sentences each starting with a verb). We'll treat as list.
Then "Education/Experience What You Bring" includes bullet-like sentences but not formatted as list. We need to turn into list.
Then "Additional Licensing, Certifications, Registrations" etc.
Then "Knowledge" etc.
Then "Skills And Abilities" list.
Then "Travel Up to 25%Travel primarily within State of NJ may be required. Occasional travel in the tri-state areas may also be required.Positions for the exchange population are field based and will require travel."
Then "Why Horizon?" paragraph.
Then benefits list: "Comprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition Reimbursement"
Then disclaimer etc to remove.
We need to ensure we don't duplicate content. For Requirements, we should combine Education/Experience, Additional Licensing..., Knowledge, Skills And Abilities into one Requirements section? The instruction: Prefer a few substantive sections over many thin ones. So we could combine all requirement-related info into a single Requirements section with sublists? But we must use
- for any list. Could have multiple
- inside the section. Or we could have separate headings for each subcategory? But they said prefer few substantive sections over many thin ones. So maybe one Requirements section containing multiple
- ... ...
- High School Diploma/GED required.
- Bachelor degree in Nursing preferred or relevant experience in lieu of degree.
- Requires a minimum of two (2) years clinical experience.
- Prefer experience with the elderly, frail and those with chronic conditions.
- Requires a minimum of three (3) years' experience in the health care delivery system/industry.
- Requires a minimum of two (2) years' experience with health care payer experience.
- Active Unrestricted RN License Required; NJ License Preferred.
- Requires a valid Driver's License and Insurance.
- Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, 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.
- 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
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
- groups each preceded by a
heading? But we cannot use headings inside section besides the main
. We could use
to label subparts like "Education/Experience:" then a
- . That's acceptable.
Thus structure:
About the Role
... (the paragraph about role)
Responsibilities
Requirements
Education/Experience:
Additional Licensing, Certifications, Registrations:
Knowledge:
Skills And Abilities:
Benefits
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!
Pay
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.
Schedule
Travel Up to 25% Travel primarily within State of NJ may be required. Occasional travel in the tri-state areas may also be required. Positions for the exchange population are field based and will require travel.
We need to ensure we removed boilerplate: the disclaimer about Horizon BCBSNJ employees must live in NJ etc., and EEO statement. Also remove any duplicated lines. The "About The Role" paragraph we included. Ensure we didn't include any application instructions (none present). Also remove any "Why Horizon?" duplicated? We kept the paragraph. Check for any leftover boilerplate: The text after benefits includes disclaimer and EEO. We removed. Now ensure we didn't miss any substantive info: The "About The Role" paragraph we captured fully? Let's verify original: "About The Role This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high risk members on an annual basis and will work to engage these members in preventative care opportunities & screenings, including opportunities in retail settings if possible. This position is responsible for performing RN duties for members in commercially risk adjusted products , 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. When appropriate, there will be responsibility for ensuring members are engaged for annual wellness visits. This position will leverage analytical insights from RAM to create clinical strategies that drive encounters for high-risk members that support commercial risk adjustment initiatives. This position serves as a mentor/trainer to new RN's and other staff as needed. Positions involving the commercially risk adjusted population may require travel." We included that as paragraph. Good. Now "What You'll Do" list: Let's extract each bullet: - Facilitates the navigation of high risk members to appropriate settings of care for annual wellness visits, including outreach to members, providers and retail pharmacies. - Coordinates transition of member from RAM RN to care management RN based qualification for CM program and member commitment to participation. - Encourages member participation and compliance in the case/disease management program efforts - Works closely with RAM Business Analyst and Manager to engage at-risk members in commercially risk adjusted markets. - Deploys clinical engagement strategy to integrate clinical insights from multiple information sources, including RAM, member outreach calls, or retail pharmacies. - Performs ad-hoc clinical outreach strategy development to highest risk members to support commercial risk adjustment tactics. - Interprets analytical reports as developed by the RAM team to deploy clinical outreach strategy. - Develops & expands member outreach initiatives to case / disease management eligible members, including driving potential physician or pharmacy visits. - Assesses member's clinical need against established guidelines and/or
- for any list. Could have multiple