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Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
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.
Registered Nurse (RN) with a focus on Nutrition Case Management combines the core responsibilities of acase managerwith specialized expertise innutrition. This role is dedicated to ensuring patients receive comprehensive and individualized care that addresses their nutritional needs, especially for those with complex or chronic conditions.
Responsibilities:
- Assessment:Evaluate patient's nutritional status, needs, dietary habits, lifestyle factors, and existing support network.
- Care Planning:Develop and manage individualized care plans incorporating nutritional interventions based on the patient's medical conditions and recovery needs.
- Coordination:Act as a liaison between patients, families, and healthcare providers (physicians, dietitians, social workers, etc.) to ensure seamless care delivery and access to appropriate services. This can include scheduling appointments, therapies, and other medical services.
- Advocacy:Champion the patient's needs and preferences within the healthcare system, ensuring they receive high-quality, cost-effective care and addressing any barriers to treatment.
- Education and Guidance:Educate patients and families on their health conditions, treatment options, self-management strategies, and the role of nutrition in managing their health.
- Monitoring and Evaluation:Track patient progress, monitor health outcomes (e.g., lab results, weight changes), and adjust care plans as needed to optimize health outcomes.
- Resource Utilization:Facilitate referrals to community resources, including nutrition support services, food banks, and other programs that address social determinants of health impacting nutrition.
Addendum for Horizon Clinical Advocate Roles:
Outreaches to members identified by Horizon as needing Clinical Advocate services. Applies critical thinking and clinical expertise to maximize outcomes while interacting with members and their families in a fast-paced environment. Builds trusting relationships with members and their families utilizing Motivational Interviewing techniques. Becomes knowledgeable in ASO client employer -sponsored benefits to assist members with questions related to medical benefits, claims, care coordination and other complex needs through explaining benefits and providing education and resources in plain language. Advocates for members consistently throughout their healthcare journey by coordinating with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. Focuses on whole person approach, by eliminating "homework" or unnecessary burdens on the members, we can provide a more supportive and engaging experience that addresses overall well-being physical, mental, and emotional. Schedule: 8- or 10-hour workday Monday through Friday varying between 8am and 11pm.
Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education/Experience:
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.
Additional licensing, certifications, registrations:
Knowledge:
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). Should be knowledgeable in the use of intranet and internet applications. Requires knowledge of hospital structures and payment systems. Requires working knowledge of case/care/disease management principles. Requires working knowledge of operations of utilization, case and/or disease management processes. Requires knowledge of health care contracts and benefit eligibility requirements. Requires mentoring knowledge on the operations of utilization/case/disease management.
Addendum for Horizon Clinical Advocate roles:
Requires ability to be an empathetic critical thinker. Requires excellent communication and organizational skills and a high tolerance for ambiguity. Ability to understand and communicate members benefits, claims and coordination focusing on advocacy principals and effective utilization. Experience in active listening and motivational interviewing strongly preferred. Requires a candidate that can work in a collaborative team environment and is a team player who possesses strong analytical, critical thinking and interpersonal skills. Requires exceptional multi-channel Communication and Interpersonal skills, including the ability to explain complex concepts clearly with compassion.
Skills and Abilities:
Adaptability/Flexibility Analytical Compassion Interpersonal & Client Relationship Skills Information/Knowledge Sharing Judgment Listening Planning/Priority Setting Problem Solving Team Player Time Management Written/Oral Communication & Organizational Skills
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Salary Range: $77,900 - $104,370
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. Horizon also provides a comprehensive compensation and benefits package which includes:
Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, 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 recruiting and hiring process.
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Horizon Blue Cross Blue Shield of New Jersey
tuition reimbursement
Aug 05, 2025