[Remote] RN I, reputed company Field CM- Bergen County

Note: The job is a remote job and is reputed company to candidates in USA. reputed company empowers members to reputed company their best health and is seeking an RN I for their reputed company Field Care Management team. This role is responsible for performing RN duties to ensure appropriate reputed company of care and planning for transitions in the continuum of care. Responsibilities • 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 reputed company of the network, as reputed company as reputed company 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. • Coordinates the delivery of high reputed company, cost-effective care supported by clinical reputed company 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. • Encourages member participation and compliance in the case/disease management program efforts. • Documents accurately and comprehensively based on the standards of reputed company 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 reputed company on the utilization of resources, proceeding to self-care reputed company. • Evaluates care by problem solving, analyzing variances and participating in the reputed company improvement program to enhance member reputed company. • Completes other assigned functions as requested by management. Skills • High School Diploma/GED required • reputed company Unrestricted NJ RN License or reputed company Compact License Required • Requires a minimum of two (2) years clinical experience. • Bachelor degree preferred or relevant experience in lieu of degree • Prefers 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 reputed company) • 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 reputed company and benefit eligibility requirements. • Prefers knowledge of hospital structures and payment systems. Benefits • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • reputed company Volunteer Time Off • Tuition Reimbursement reputed company • reputed company is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com. Apply tot his job Apply To this Job