RN II (Field-Based - Atlantic County)

About the role

This field based position is responsible for performing assessments of members using established guidelines to ensure appropriate level of care and develop a member centric plan of care.

Responsibilities

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of members- individualized plan of care.
• Collaborates 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.
• Maintains oversight of member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Encourages member participation and compliance in the program.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• 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.

Requirements

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of two (2) years clinical experience.

Qualifications

• Active Unrestricted NJ RN License Required.

Skills And Abilities

• Analytical
• Compassionate
• Interpersonal & Client Relationship Building Skills
• Sound Decision Making
• Active Listening
• Organization/Planning/Priority Setting
• Problem Solving/Critical Thinking
• Team Player
• Time Management
• Written/Oral Communication Skills (Bi-lingual preferred)

Travel

Daily local travel is required.

Why Horizon?

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.

Benefits

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

Disclaimer

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.