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RN II – Primary Nurse Care
Horizon Connect @ Wall BCBSNJCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care coordination, member advocacy, and clinical assessment while effectively engaging with multidisciplinary teams to enhance patient outcomes. Proficient in case management principles and committed to quality improvement in healthcare delivery.
Highest-signal resume keywords
Active Unrestricted RN LicenseClinical ExperienceCase Management PrinciplesUtilization ManagementBilingual Proficiency
About the role
Key responsibilities & impact- Perform RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care
- Plan transitions to the continuum of care and develop member-centric plans of care
- Conduct outreach to high-risk members and engage members in preventative care opportunities and screenings
- Assess members' clinical needs against guidelines and standards
- Facilitate responses to gaps in care and direct high-risk members to appropriate care settings
- Evaluate the necessity, appropriateness, and efficiency of acute and chronic medical services and procedures
- Develop, coordinate, and assist with individualized plans of care and identify barriers to self-management and wellness
- Coordinate with members, families, physicians, hospitals, and external customers
- Coordinate high-quality, cost-effective care across the continuum, including transitional care
- Monitor medical care activities and outcomes for appropriateness and effectiveness
- Advocate for members and families across care sites
- Encourage participation and compliance in case/disease management programs
- Document accurately and comprehensively according to standards and organizational policies
- Communicate with multidisciplinary teams telephonically and/or in person
- Evaluate care, analyze variances, and participate in quality improvement programs
- Mentor and train new RNs and other staff
- Present clinical cases during external review audits
- Perform other duties assigned by management
Requirements
What you’ll need- High School Diploma/GED required
- Bachelor degree preferred or relevant experience in lieu of degree
- Minimum of two (2) years clinical experience
- Minimum of three (3) years' experience in the health care delivery system/industry
- Active Unrestricted RN License Required; NJ License required and/or Compact License
- Valid Driver's License and Insurance
- Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook
- Working knowledge of case/care/disease management principles
- Working knowledge of operations of utilization, case and/or disease management processes
- Working knowledge of principles of utilization management
- Basic knowledge of health care contracts and benefit eligibility requirements
- Knowledge of hospital structures and payment systems
- Bi-lingual proficiency preferred
- Travel primarily within State of NJ may be required; occasional travel in the tri-state area may also be required
- Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Benefits
Comp & perks- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentCare CoordinationQuality ImprovementMember-Centric Care PlanningPreventative Care EngagementDocumentation StandardsHealth Care Contracts KnowledgeBenefit Eligibility RequirementsTransitional Care CoordinationMonitoring Medical Care Activities
Soft Skills
AdvocacyMentoringCommunicationCollaborationProblem-Solving
Tools & Technologies
MS Office ProductsMicrosoft OutlookWindows Based Software
Certifications & Qualifications
RN LicenseNJ LicenseCompact License
Industry Keywords
Health Care Delivery SystemDisease ManagementUtilization ManagementHigh-Risk Member OutreachClinical Needs Assessment