LPN I

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 LPN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care under the direction/supervision of an RN. Performs duties and types of care management as assigned by management.

Job Responsibilities:
Performs the following job responsibilities under the direction/supervision of an RN:

• 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.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Monitors patient-s medical care activities, regardless of the site of service, and outcomes 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 practice and current organization policies.
• Interacts and communicates with multidisciplinary teams either telephonically and/or on site 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.
• Performs special projects as assigned by management.

Addendum:
Community Health Nurse I

This position is responsible for performing clinical screenings and care management using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. This position is also responsible for actively coordinating and promoting Horizon NJ Health's position and services to community organizations, groups and Individuals through marketing.

Additional Responsibilities include:

• Conducts preventive health screenings and documents health data related to specific preventive screening.
• Responsible for educating and enrolling potential members into HNJH products through marketing.
• Serves as a representative at company sponsored community events and coordinates all on-site responsibilities. (Must be available to work evenings and weekends.)

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:

• Prefers an Associates degree from an accredited college or university in health care management or related field.
• Requires a minimum of one-year clinical experience in an acute care facility.
• Requires a minimum of one-year experience in the health care delivery system/industry.
• Prefers quality initiative experience.

Additional licensing, certifications, registrations:

• Active Unrestricted NJ LPN License Required

Knowledge:

• Required knowledge of medical terminology.
• Prefers knowledge of managed car