Full-Time
Registered Nurse 1
Utilization Management
Posted on 9/17/2025
Horizon NJ Health
1,001-5,000 employees
Not-for-profit health insurer offering medical plans
Compensation Overview
$69.5k - $93k/yr
Company Does Not Provide H1B Sponsorship
Princeton, NJ, USA
Remote
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.
 Medical, Clinical & Veterinary (1) |
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- 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.
- 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 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.
- 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.
- Analytical
- Compassion
- Interpersonal & Client Relationship Skills
- Judgment
- Listening
- Planning/Priority Setting
- Problem Solving
- Team Player
- Time Management
- Written/Oral Communication & Organizational Skills
Horizon NJ Health is a not-for-profit health insurer serving New Jersey. It offers a range of health insurance products for individuals, families, and employers, including medical plans such as HMOs and Medicare coverage for eligible people. The company collects premiums from its members and uses the funds to pay for member care through a network of doctors, hospitals, and healthcare providers. Any excess revenue is reinvested into the company to improve benefits and services for members, rather than distributing profits to shareholders. Horizon BCBSNJ holds a large market share in New Jersey and aims to provide access to comprehensive, affordable health coverage through a broad provider network. Its goal is to deliver reliable health insurance coverage and dependable care options that meet the needs of its members throughout the state.
Company Size
1,001-5,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Newark, New Jersey
Founded
1932
Simplify's Take
What believers are saying
- Self-funded plans cover 67% of NJ workers per KFF 2025 survey.
- TPA market hits $404B in 2026 with 8.7% CAGR per Research.
- Over 400,000 NJ TPA members seek Horizon solutions per VP Ferguson.
What critics are saying
- UnitedHealthcare undercuts premiums 10-15%, erodes 500,000 members in 12 months.
- NJ DOI fines $150M for MLR failure in MLTSS, hikes premiums in 6 months.
- Centene bids 12% lower rates, displaces 200,000 slots in 18 months.
What makes Horizon NJ Health unique
- Horizon NJ Health launches HealthEZ TPA in 2026 for self-funded NJ employers.
- HealthEZ combines Horizon's NJ provider network with customizable benefits.
- Targets 50-2,000 employee NJ firms launching January 1, 2027.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
401(k) Retirement Plan
Unlimited Paid Time Off
Wellness Program
Tuition Reimbursement
Company News
Three Newark-based companies plan to lay off hundreds of workers in the coming months, according to the state Department of Labor. Horizon Blue Cross Blue Shield of New Jersey will cut 242 jobs from 26 April, whilst Prudential Financial plans to eliminate 54 positions starting 7 May. Luna Foods, also known as Joey's Fine Foods, will lay off 61 employees from 5 June. Prudential, founded in Newark in 1875 and still headquartered there, said it continually reviews its organisational structure to meet evolving customer needs and maintain competitiveness. The company stated it is eliminating roles that no longer align with its strategy. Horizon Blue Cross Blue Shield, which insures approximately one million New Jerseyans, did not immediately comment. Luna Foods also did not respond.
Horizon Blue Cross Blue Shield of New Jersey partners with Upside to expand housing stability services statewide. Statewide initiative addresses housing instability - a critical barrier to health - for New Jersey's Medicaid population FORT LAUDERDALE, FL and NEWARK, NJ - Upside, a nationally scalable housing stability solution, today announced a partnership with Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBS) to provide comprehensive housing support services to Medicaid members across the Garden State. Beginning January 2026, Upside will deliver Pre-Tenancy Services, Tenancy Sustaining Services, Move-in Supports, and Community Transition Services as part of NJ FamilyCare's Housing Supports Program - making these critical interventions available to eligible Horizon NJ Health members statewide. The partnership addresses an urgent need: New Jersey faces a severe housing affordability crisis, with only 31 affordable rental homes available for every 100 extremely low-income households. Seventy-four percent of extremely low-income renters in the state spend more than half their income on housing, forcing impossible choices between rent, food, and healthcare. For Medicaid members already managing chronic conditions, housing instability becomes a health crisis - dramatically increasing emergency room visits, hospitalizations, and healthcare costs. "We're excited to bring Upside's proven housing stability solutions to New Jersey," said Jake Rothstein, Co-Founder and CEO of Upside. "Housing isn't separate from healthcare - it's fundamental to it. When someone doesn't have a stable place to live, managing diabetes becomes nearly impossible. Keeping up with medications, attending appointments, even storing insulin safely - all of it depends on having a home. This partnership with Horizon BCBS allows us to intervene before housing instability derails health, connecting members to safe, supportive housing and the wraparound services they need to thrive." Upside's model combines human-powered care navigation with AI-supported housing orchestration to deliver personalized support at scale. Dedicated Care Guides - licensed social workers and housing specialists - work directly with referred members to assess their unique situations, develop customized housing plans, and navigate complex systems including landlord negotiations, application assistance, eviction prevention, and connections to community resources. The platform serves members across three housing readiness levels, from crisis intervention to long-term tenancy support. Life Sustaining results, national scale. Since its founding in 2020, Upside has stabilized thousands of vulnerable members across multiple Medicaid managed care partnerships, demonstrating measurable reductions in emergency care use, hospitalizations, and fall risk. For members ready to be housed, Upside achieves an 85% stabilization rate in an average of 70 days. The company's Care Guides - who bring expertise in behavioral health, real estate, and social services - provide rapid, personalized support from the moment of referral. Services are available in 240+ languages, ensuring accessibility for New Jersey's diverse Medicaid population. Horizon members experiencing housing instability or at risk of homelessness will be referred to Upside through the health plan's care management teams. Upside's services address the full spectrum of housing needs - from helping someone find their first apartment after leaving a nursing facility, to preventing eviction for a family one paycheck away from losing their home, to supporting seniors who need accessibility modifications to age safely in place. Addressing social determinants at scale. The Horizon-Upside partnership reflects a broader national movement recognizing that healthcare outcomes are inextricably linked to social determinants like housing. Research shows that adults experiencing homelessness have health profiles equivalent to someone 20 years older, and housing insecurity alone raises the odds of stress by nearly 50% - a direct precursor to costly healthcare utilization. New Jersey is among eight states with CMS-approved Section 1115 demonstrations under the Health-Related Social Needs framework, enabling Medicaid programs to invest in evidence-based housing interventions. By integrating housing stability services directly into managed care, Horizon BCBS aims to improve member health outcomes, reduce avoidable emergency care, and address healthcare costs at their root cause. About Upside. Upside is a nationally scalable housing stability solution that helps health plans proactively identify and stabilize vulnerable members. The platform connects Medicaid and Medicare populations to safe, supportive housing, reducing emergency care usage and improving health outcomes. Founded in 2020 and headquartered in Fort Lauderdale, FL, Upside has raised funding from distinguished investors including 645 Ventures, Freestyle Capital, and Triple Impact Capital. For more information, visit www.joinupside.com. About Horizon Blue Cross Blue Shield of New Jersey. Horizon Blue Cross Blue Shield of New Jersey is the state's largest health insurer. As an independent licensee of the Blue Cross Blue Shield Association, Horizon BCBS is committed to improving the health and well-being of the communities it serves. Horizon NJ Health is an affiliate of Horizon BCBS and the largest Medicaid Managed Care Organization in New Jersey. Media Contact: Spencer Smith Vice President of Marketing, Upside ssmith [at] joinupside.com
NJ Transit, Horizon pitch 1k-unit mixed-use with HQ in Newark. The basics: * NJ Transit, Horizon propose 1,000 apartments and new HQ in Newark * JLL, CBRE soliciting developer interest for the 3-acre site * Plans include a 250,000-SF class A office tower for Horizon * Project aligns with NJ Transit's LAND Plan to boost long-term revenue NJ Transit and Horizon Blue Cross Blue Shield of New Jersey are presenting a development opportunity that would transform Newark offices owned by the entities into a new mixed-use development featuring 1,000 apartments. In addition to the residential revamp, plans also include construction of a new, single-tenant Class A office building. That 250,000-square-foot base would serve as Horizon's new headquarters. JLL and CBRE announced Dec. 2 they will collaborate on behalf of ownership to solicit interest in the project. Situated on 3 acres, the spot offers unobstructed views of the Passaic River and New York City skyline. It also presents potential for the city. The redevelopment would feature easy access to Newark Penn Station, along with the Ironbound. Having formerly occupied 1 Penn Plaza East, NJ Transit recently moved to Gateway Center in Newark after signing a 25-year agreement for approximately 407,000 square feet of space. Built in 1992, Horizon BCBS purchased its 21-story headquarters at 3 Penn Plaza East for $145.8 million in 2010. The company has called Newark home since its founding almost a century ago. JLL and CBRE noted both the redevelopment work and the office building site will require city approvals. The former represents NJ Transit while the latter is representing Horizon Blue Cross Blue Shield. Get in on the action. Potential developers should register their interest here by Dec. 31, 2025, to receive a copy of a Confidential Information Memorandum with further information. Interested developers may also receive an invite to attend a future Information Sharing Event hosted by JLL and CBRE. The ISE would offer: * Additional details regarding the anticipated timeline and bidder evaluation criteria * Illustrative potential financial models and proformas * Answers to questions either submitted in advance of or during the event The commercial real estate firms said NJ Transit may also issue a procurement for the project. If it commences that process, it is expected to involve a Request for Proposals. Attendance at the ISE is not mandatory for eventual participation in any procurement process. Bigger picture. NJ Transit also disclosed details about the proposed two-phase process Tuesday. For the agency, the move coincides with an updated real estate strategy. Unveiled in October, NJ Transit has said its LAND Plan could generate up to $1.9 billion in non-fare revenue over the next 30 years. According to NJ Transit CEO Kris Kolluri, the move to redevelop the agency's former HQ is a "key step" in advancing that strategy. The chief executive said both initiatives reflect "our disciplined approach to generating incremental revenue for NJ TRANSIT, while contributing to economic growth across the state and in cities such as Newark through new jobs, housing and long-term investment." Newark Mayor Ras Baraka spoke positively about the project. Commenting on the proposal, he said the "future-facing redevelopment will be a crowning jewel in Newark's continuing ascent." Baraka also highlighted the buy-in from local tenants and corporate anchors Horizon and NJ Transit. "Their investment will create new spaces for living, working and recreation, enliven our downtown, enhance our riverfront, and attract residents eager to benefit from the most extensive tri-state rail network in the nation," he said. "Newark embraces this collaboration with full support for the broader public private partnership that it represents." CBRE Executive Vice President Gil Medina also noted "the coordinated effort," which will keep both organizations in the city while advancing redevelopment aspirations. "As technology continues to improve how Horizon serves its members, the company's new headquarters will allow it to operate more efficiently and in a smaller footprint, while offering its employees and guests a modern, collaborative environment in the heart of Newark," Medina said. JLL Executive Vice President Ron Simoncini noted the project evolved out of "many months of discussion." The parties anticipate tapping into local resources to help bring the project to fruition. JLL and CBRE specifically highlighted the New Jersey Economic Development Authority's Aspire NJ program. That incentive program aims to close financing gaps for large-scale, mixed-use projects that drive long-term urban revitalization. "The ASPIRE program facilitates just this sort of opportunity," Simoncini said. "And in addition to our gratitude to the amazing collaboration of Horizon and NJ TRANSIT, the Murphy Administration deserves credit for energizing the development community,"
Horizon BCBSNJ has advised that 2026 GCNJ Certification training is further delayed. GCNJ will send an update once training is made available and all agents will be required to complete any assigned marketplace training within 30 days of receiving notice from GCNJ. Agents are permitted to sell all Individual Marketplace health plans beginning November 1 if they have a valid 2025 GCNJ Certification. Horizon is currently working with their partners at Miramar Agent to make necessary updates to their platform for ON Exchange registrations. * Please delay completion of registration for the next 7 days as they Pgpbenefits work to modify the ON Exchange registration process * Registration for OFF Exchange, ICHRA and SHOP workflows will remain active.
HABcore receives $25,000 grant from Horizon Blue Cross Blue Shield of New Jersey to support the nonprofit's Independence Pathways Program.