RN II, Case Manager – Pediatrics
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Job Description
RN II/ Case Manager for Pediatrics at Horizon Blue Cross Blue Shield supporting care management and transitions. Focusing on member advocacy and clinical engagement in a remote role.
Responsibilities:
- Performs 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
- Evaluates the necessity, appropriateness and efficiency of medical services
- Coordinates and assists in the implementation of care plans for members
- Monitors and coordinates services rendered outside of the network
- Advocates for members among various sites to coordinate resource utilization
- Documents accurately based on the standards of practice
- Acts as a subject matter expert for projects and committees
- Serves as mentor/trainer to new RN's and staff as needed
Requirements:
- High School Diploma/GED required
- Bachelor degree preferred or relevant experience in lieu of degree
- Minimum of two (2) years clinical experience required
- Minimum of two (2) years’ experience with health care payer experience required
- Active Unrestricted NJ RN License or active Compact License Required
- CCM certification preferred for Clinical Advocate roles
- Proficient in the use of personal computers and MS Office products
- Knowledgeable in hospital structures and payment systems
- Working knowledge of case/care/disease management principles and processes
- Must be able to work collaboratively in a team environment
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
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