RN II, Primary Nurse Care

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Execute RN responsibilities for the Primary Nurse population following established protocols.

• Develop member-focused care plans and facilitate transitions within the continuum of care.

• Reach out to high-risk members and encourage participation in preventative care and screenings.

• Evaluate members' clinical requirements based on guidelines and standards.

• Address care gaps and organize annual wellness visits in collaboration with healthcare providers.

• Assess the necessity, appropriateness, and efficiency of acute and chronic medical services and procedures.

• Create, coordinate, and support personalized care plans while identifying obstacles to self-management and wellness.

• Collaborate with members, families, physicians, hospitals, and external stakeholders regarding care appropriateness.

• Ensure high-quality, cost-effective care throughout the continuum, including transitional care.

• Monitor medical care activities and outcomes for their appropriateness and effectiveness.

• Advocate for members and families across various care settings.

• Promote member engagement and adherence in case and disease management programs.

• Accurately document information in accordance with practice standards and organizational policies.

• Communicate with multidisciplinary teams via telephone and/or in person.

• Assess care, analyze discrepancies, and engage in quality improvement initiatives.

• Mentor and train new RNs and other staff members.

• Present clinical cases during audits conducted by external review organizations.

• Carry out additional duties as assigned by management.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• A Bachelor's degree is preferred, or relevant experience may be accepted in lieu of a degree.

• A minimum of two (2) years of clinical experience is required.

• At least three (3) years of experience in the healthcare delivery system or industry is necessary.

• An active and unrestricted RN License is required; NJ License and/or Compact License are necessary.

• A valid Driver's License and insurance are required.

• Proficiency in personal computers and software applications in a Windows environment is essential.

• Competence with MS Office applications (Word, Excel, PowerPoint) and Microsoft Outlook is necessary.

• Familiarity with case, care, and disease management principles is important.

• Understanding of utilization, case, and/or disease management processes is required.

• Knowledge of utilization management principles is essential.

• Basic understanding of healthcare contracts and benefit eligibility requirements is necessary.

• Familiarity with hospital structures and payment systems is essential.

• Horizon BCBSNJ employees must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

• Bilingual proficiency is preferred.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision coverage.

• Retirement plans available.

• Generous Paid Time Off (PTO).

• Incentive plans offered.

• Wellness programs to promote health and well-being.

• Paid Volunteer Time Off.

• Tuition reimbursement opportunities.