Horizon Blue Cross Blue Shield of New Jersey · 1 day ago
RN I
United States
Full-time
Remote
Entry Level
$70K/yr - $94K/yr
2+ years expHorizon Blue Cross Blue Shield of New Jersey is a health solutions leader in New Jersey, empowering members to achieve their best health. The RN I position is responsible for performing nursing duties to ensure appropriate levels of care and planning transitions within the continuum of care.
Health Care
Responsibilities
Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided
Coordinates and assists in implementation of plan for members
Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate. 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 patient'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 case/disease management program efforts
Documents accurately and comprehensively based on the standards of practice and current organization policies
Interacts and 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
Qualification
Required
High School Diploma/GED required
Requires a minimum of two (2) years clinical experience
Active Unrestricted NJ RN License or active Compact License Required
Preferred
Bachelor degree preferred or relevant experience in lieu of degree
Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook)
Prefers knowledge in the use of intranet and internet applications
Prefers working knowledge of case/care management principles
Prefers working knowledge of principles of utilization management
Prefers basic knowledge of health care contracts and benefit eligibility requirements
Prefers knowledge of hospital structures and payment systems
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
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