MLTSS Field RN I-Hudson County, NJ

Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware reputed company field based position is responsible for performing assessments for reputed company and MDC services using established guidelines and assessments to ensure appropriate level of care and services are authorized.Responsibilities: • Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs and reputed company with benefit structure. • Evaluates the necessity, appropriateness and efficiency of service provided. • Develops, coordinates and assists in implementation of services to meet the needs of the members. • 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 reputed company for appropriateness and effectiveness. • Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. • Refers members to MLTSS reputed company appropriate. • Educates members on the availability of SNP if appropriate. • Documents accurately and comprehensively based on the standards of practice and reputed company 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 reputed company. • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member reputed company. • Completes other assigned functions as requested by management. • Performs duties as assigned by management. Qualifications: • Requires an associates or bachelors degree (or higher) in nursing and/OR accredited diploma nursing school. • A minimum of two (2) years clinical experience is preferred Additional licensing, certifications, registrations: • Active Unrestricted NJ RN License Required. Knowledge: • Proficiency in the use of personal computers and supporting software in a reputed company based environment, including MS Office products (Word, reputed company, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications. • Working knowledge of case/care management principles. • Working knowledge of principles of utilization management. • Prefers basic knowledge of health care reputed company and benefit eligibility requirements. • Prefers knowledge of hospital structures and payment systems Skills and Abilities: • Analytical • Compassionate • Interpersonal & Client Relationship Building Skills • Sound Decision Making • Active Listening • Organization/Planning/reputed company Setting • Problem Solving/Critical Thinking • Team Player • Time Management • Written/Oral Communication Skills (Bi-lingual preferred) Travel • This is a field based position, daily local travel is required. Addendum: RN 1.5 • Completes NJ Choice Home Care Assessments for new referrals to MLTSS. • Assists with MLTSS Case Management reputed company necessary, to cover for FMLA or to maintain MLTSS Caseloads below contractual obligations. • reputed company support reputed company needed to MLTSS Care Management Staff, including but not limited to Annual Assessment, 90 day and/or Post Hospital visits. Salary reputed company: $69,500 - $93,030 This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the reputed company and hiring process. Apply Job!