RN II, Case Manager
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
RN II Case Manager for Horizon Blue Cross Blue Shield overseeing patient care using established guidelines. Responsible for planning, assessment, and coordination of care for members' health services.
Responsibilities:
- Responsible for performing RN duties using established guidelines to ensure appropriate level of care.
- Plans for the transition to the continuum of care.
- Assesses patient's clinical need against established guidelines.
- Coordinates and assists in implementation of plan for members.
- Monitors patient's medical care activities and outcomes for appropriateness and effectiveness.
- Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
- Serves as mentor/trainer to new RN's and other staff as needed.
- Represents clinical teams within committee meetings.
Requirements:
- High School Diploma/GED required.
- Bachelor degree preferred or relevant experience in lieu of degree.
- Minimum of two (2) years clinical experience.
- Minimum of two (2) years’ experience with health care payer experience.
- Active Unrestricted NJ RN License or active Compact License Required.
- CCM certification preferred.
- Must be proficient in the use of personal computers and supporting software in a Windows based environment.
- Knowledge of hospital structures and payment systems.
- Understanding of case/care/disease management principles.
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Similar Jobs
Senior Claims Manager – CA Workers' Compensation
Senior Claims Manager overseeing a team of claim professionals for Strategic Comp in California. Responsible for staffing, coaching, and developing claims management in a remote role.
Senior Enablement Manager
Senior Enablement Manager at Jabil providing leadership and strategy for PMO activities. Ensuring project management teams effectively execute initiatives and improve operational readiness.
RN II, Primary Nurse Care – Case Manager
RN Care Manager tasked with clinical responsibilities for high risk members. Engaging in preventative care and developing individualized care plans for optimal member outcomes.
Care Manager I, Specialty Programs
Care Manager I at Horizon Blue Cross Blue Shield coordinating care for specialty populations and implementing high-quality, cost-effective care. Manage member advocacy and resource utilization while ensuring compliance with care standards.
APAC BD and Channel Manager
Business Development Manager for LGC AXIO Proficiency Testing focusing on the South Korea and Japan markets. Developing relationships, acquiring partners, and driving sales strategies to meet revenue goals.
Asset Manager, Foreclosure
Asset Manager supporting foreclosure processing and auctions at Altisource. Listing, tracking, and managing foreclosure properties for timely sales and compliance.
Area Manager
Area Manager at GoFi responsible for driving loan volume and building dealer relationships. Focused on consultative selling, training, and strategic influence to maximize market presence.
Manager, RCM Services
Manager overseeing RCM services for a behavioral health organization. Leading and mentoring a billing team to ensure operational goals and client satisfaction.
Customer Assistance Manager
Customer Assistance Manager managing efficient operations and logistics for the leasing business. Ensuring exceptional customer service and driving performance in the Dallas area with high travel requirements.
Manager, Advanced Analytics
Manager in Advanced Analytics overseeing data projects and team analytics in a remote setup. Engaging in health measurement expertise and implementing business intelligence solutions.
Business Area Manager – Nursing
Business Area Manager overseeing remote Field Nurses to drive operational excellence at Cencora. Focused on Key Performance Indicators and maintaining high standards of nursing operations.
Field Nurse Case Manager
Field Nurse Case Manager managing patient enrollment and reimbursement processes for Cencora's healthcare programs. Collaborating with physicians while supporting patients throughout their care and therapy processes.
Critical Care Business Manager – INOmax
Business Manager leading commercial efforts for inhaled nitric oxide therapy in Eastern Canada. Collaborating with medical and commercial teams to grow medical device usage in targeted hospitals.
Field Reimbursement Manager
Field Reimbursement Manager providing access and reimbursement support for Keenova products. Collaborating with healthcare providers and internal teams to facilitate patient access.
Engagement Team Manager
Engagement Team Manager overseeing member outreach at RightMove Health. Leading a team and enhancing engagement strategies while providing direct support to members via the phone.
Assistant Manager, Curriculum and Instruction
Assistant Manager responsible for leading educational programs at Texas Virtual Academy. Ensuring compliance with educational standards and managing staff in a remote environment.
Manager, Public Sector
Manager Acquisition Hunting leading sales in the public sector at HPE. Responsible for customer engagement, team performance, and strategic sales management.
Regional Retail Manager
Retail Regional Manager responsible for overseeing and developing retail sales organization at Acosta. Ensuring adherence to company policies and enhancing sales coverage in assigned territory.
Practice Transformation Manager
Practice Transformation Manager leading implementation of value-based care programs at Vytalize Health. Collaborating with providers to optimize health management strategies and improve patient outcomes.
IT Lizenzmanager
IT Lizenzmanager at OneQrew ensuring compliant software license management and strategic alignment with IT and business. Focus on risk minimization and audit readiness while managing software licenses.