NJM Insurance Group logo
NJM Insurance Group

More Than 100 Years of Earning Trust

RN II, Field Based

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

Location

New Jersey

Posted

1 day ago

Salary

$79.1K - $105.9K / year

Seniority

Mid Level

High School2 yrs expExperience acceptedEnglish

Job Description

RN II, Field Based

NJM Insurance Group

• Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members' needs • Evaluates the necessity, appropriateness and efficiency of services provided • Develops, coordinates and assists in implementation of members- individualized plan of care • 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 member'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 program • 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

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
  • Active Unrestricted NJ RN License Required
  • Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes
  • Working knowledge of case/care management principles
  • 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

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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