More Than 100 Years of Earning Trust
RN II – Primary Nurse Care, Case Management
Location
New Jersey
Posted
7 days ago
Salary
$79.1K - $105.9K / year
Seniority
Mid Level
Job Description
RN II – Primary Nurse Care, Case Management
NJM Insurance Group
• Assess member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure • Facilitate response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider • Evaluate the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs • Develop, coordinate and assist in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness • Coordinate with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome • Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care including transitional care • Monitor member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness • Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided • Encourage member participation and compliance in the case/disease management program efforts • Document accurately and comprehensively based on the standards of practice and current organization policies • Interact and communicate with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care • Evaluate care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes • Serve as mentor/trainer to new RN's and other staff as needed • Present clinical cases during audits conducted by external review organizations • Perform other duties as assigned by management
Job Requirements
- High School Diploma/GED required
- Bachelor degree preferred or relevant experience in lieu of degree
- Minimum of two (2) years clinical experience
- Experience with both acute and chronic conditions preferred
- Minimum of three (3) years' experience in the health care delivery system/industry
- Health care payer experience strongly preferred
- Active Unrestricted RN License Required; NJ License required and/or Compact License
- Requires a valid Driver's License and Insurance
- Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook
- Working knowledge of case/care/disease management principles
- Working knowledge of operations of utilization, case and/or disease management processes
- Requires working knowledge of principles of utilization management
- Basic knowledge of health care contracts and benefit eligibility requirements
- 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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Meeting Planner, Life Sciences
BCDBCD Travel helps companies travel smart and achieve more. We drive program adoption, cost savings, and talent retention through digital experiences that simplify business travel. Our 15,000+ dedicated team members service clients in 170+ countries as we shape a sustainable future for business travel. BCD’s leading meetings and events management and global consultancy services complete our comprehensive suite of solutions for all aspects of corporate travel. In 2024, BCD achieved US$22.9 billion in sales. For more information, visit www.bcdtravel.com . Get to know us by reading our blog and checking out our social media: Blog LinkedIn Instagram Facebook
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