[Hiring] RN II- CASE MGR.TRANSPLANT @Horizon Blue Cross Blue Shield of New Jersey

Role Description

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and committees as needed.

SHIFT TIME: 11am-8pm

The Transplant Case Manager acts as an individual’s primary advocate and care coordinator throughout the entire transplant journey, from initial evaluation and education to post-transplant recovery and long-term care. The Transplant Case Manager navigates complex medical, social, and financial barriers by coordinating with multiple providers and agencies, ensuring appropriate care access, and providing crucial support to individuals and their families during a challenging and emotional process.

Qualifications

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of two (2) years clinical experience.
• Requires minimum of two (2) years’ experience with health care payer experience.
• Active Unrestricted NJ RN License or active Compact License Required.
• CCM certification preferred.

Requirements

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook).
• Knowledge of hospital structures and payment systems.
• Working knowledge of case/care/disease management principles.
• Working knowledge of operations of utilization, case and/or disease management processes.
• Knowledge of health care contracts and benefit eligibility requirements.
• Mentoring knowledge on the operations of utilization/case/disease management.
• Ability to be an empathetic critical thinker.
• Excellent communication and organizational skills and a high tolerance for ambiguity.
• Ability to understand and communicate members benefits, claims and coordination focusing on advocacy principles and effective utilization.
• Experience in active listening and motivational interviewing strongly preferred.
• Ability to work in a collaborative team environment.
• Strong analytical, critical thinking and interpersonal skills.
• Exceptional multi-channel communication and interpersonal skills.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Salary Range

$79,100 - $105,945

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.