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NJM Insurance Group logo
NJM Insurance Group

More Than 100 Years of Earning Trust

RN II Utilization Manager

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

Location

New Jersey

Posted

94 days ago

Salary

$79.1K - $105.9K / year

Seniority

Mid Level

High School2 yrs expEnglish

Job Description

RN II Utilization Manager

NJM Insurance Group

• Performing RN duties using established guidelines to ensure appropriate level of care • Planning for the transition to the continuum of care • Performs duties and types of care management as assigned by management • Serves as mentor/trainer to new RN's and other staff as needed • Subject matter expert for various projects and committees • Assesses patient's clinical need against established guidelines • Evaluates necessity, appropriateness and efficiency of medical services • Coordinates and assists in implementation of plan for members • Advocates for the member/family among various sites for resource utilization and evaluation of services • Encourages member participation and compliance in case/disease management efforts • Documents accurately based on the standards of practice and organizational policies

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 personal computers and MS Office products (Word, Excel, PowerPoint, Outlook)
  • Requires knowledge of hospital structures and payment systems.
  • Requires a candidate that can work in a collaborative team environment and is a team player who possesses strong analytical, critical thinking and interpersonal skills.

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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