RN II, Care Manager – Ortho/Transplant
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
- Acts as an individual’s primary advocate and care coordinator throughout the entire transplant journey, from initial evaluation and education to post-transplant recovery and long-term care
- Navigates complex medical, social, and financial barriers by coordinating with multiple providers and agencies
- Ensures appropriate care access and providing crucial support to individuals and their families during a challenging and emotional process
- Assesses patient's clinical need against established guidelines and/or standards
- 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 and evaluation of services provided
- Documents accurately and comprehensively
- Interacts and communicates with multidisciplinary teams for continuity and efficiency
- Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes
- Builds trusting relationships with members and their families utilizing Motivational Interviewing techniques.
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)
- Knowledge of hospital structures and payment systems
- Working knowledge of case/care/disease management principles
- Working knowledge of operations of utilization, case and/or disease management processes
- Knowledge of health care contracts and benefit eligibility requirements
- Mentoring knowledge on the operations of utilization/case/disease management
- Requires ability to be an empathetic critical thinker
- Requires excellent communication and organizational skills and a high tolerance for ambiguity
- Experience in active listening and motivational interviewing strongly preferred
- Candidate must be a team player who possesses strong analytical, critical thinking and interpersonal skills
- Exceptional multi-channel Communication and Interpersonal skills, including the ability to explain complex concepts clearly with compassion.
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 experiencehealth care payer experiencecase managementcare managementdisease managementutilization managementmotivational interviewingproblem solvingquality improvementdocumentation
Soft Skills
empathetic critical thinkerexcellent communication skillsorganizational skillsactive listeninginterpersonal skillsteam playeranalytical skillstrust buildingcompassiontolerance for ambiguity
Certifications
NJ RN LicenseCompact LicenseCCM certification