About the Role

What You'll Do

• 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.

• 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.

Core Individual Contributor Competencies

• Customer Focus

• Accountable

• Learn

• Communicate

What You Bring

Education/Experience

• Requires an associate-s or bachelor-s degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.

• Requires a minimum of two (2) years clinical experience.

• Active Unrestricted NJ RN License Required

RN’s are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards.

• 2 holidays and 3 Saturdays or Sundays per year.

Knowledge

• 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.

Skills and Abilities

• Analytical

• Compassion

• Interpersonal & Client Relationship Skills

• Judgment

• Listening

• Planning/Priority Setting

• Problem Solving

• Team Player

• Time Management

• Written/Oral Communication & Organizational Skills

Salary Range:

​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:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement