RN II (Field Based - Camden County)
About The Role
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 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.
- 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 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 program.