RN II – High Risk Maternity & NICU Case Manager
NJM Insurance Group
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $79,100 - $105,945 per year
About the role
- 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
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical assessmentquality improvementcase managementdisease managementutilization managementcritical thinkingresource utilizationdocumentation standardshealth care payer experienceclinical expertise
Soft Skills
advocacycommunicationproblem solvingteam collaborationinterpersonal skillsorganizational skillsmember engagementmultidisciplinary teamworkcontinuity of carementoring
Certifications
NJ RN LicenseCompact LicenseCCM certification