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NJM Insurance Group logo
NJM Insurance Group

More Than 100 Years of Earning Trust

RN II – High Risk Maternity & NICU Case Manager

RiskRiskOtherRemoteMid LevelTeam 1,001-5,000Since 1913H1B No SponsorCompany SiteLinkedIn

Location

New Jersey

Posted

140 days ago

Salary

$79.1K - $105.9K / year

Seniority

Mid Level

High School2 yrs expEnglish

Job Description

RN II – High Risk Maternity & NICU Case Manager

NJM Insurance Group

• Assesses patient's clinical need against established guidelines to ensure appropriate level of care • 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 • Advocates for the member/family among various sites to coordinate resource utilization • Documents accurately and comprehensively based on standards of practice • Interacts and communicates with multidisciplinary teams to ensure continuity of care • Evaluates care by problem solving and participating in quality improvement programs • Outreaches to members identified by Horizon as needing Clinical Advocate services • Applies critical thinking and clinical expertise to maximize outcomes while interacting with members and their families

Job Requirements

  • High School Diploma/GED required
  • Bachelor degree preferred or relevant experience in lieu of degree
  • Requires a minimum of two (2) years clinical experience
  • Requires minimum of two (2) years’ experience with health care payer experience
  • Active Unrestricted NJ RN License or active Compact License Required
  • CCM certification preferred
  • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook)
  • Requires knowledge of hospital structures and payment systems
  • Requires working knowledge of case/care/disease management principles
  • Requires working knowledge of operations of utilization, case and/or disease management processes
  • Requires knowledge of health care contracts and benefit eligibility requirements
  • Requires mentoring knowledge on the operations of utilization/case/disease management

Benefits

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement

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