More Than 100 Years of Earning Trust
RN II, Field Based
Location
New Jersey
Posted
1 day ago
Salary
$79.1K - $105.9K / year
Seniority
Mid Level
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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