Telephonic Case Manager, RN II

NJM Insurance Group

Telephonic Case Manager responsible for assessing clinical needs and coordinating member care. Supporting a favorable patient journey through effective resource utilization and communication.

Posted 4/14/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $79,100 - $105,945 per yearWebsite

About the role

Key responsibilities & impact

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
Acts as subject matter expert for respective area for projects
Advocates for the member/family among various sites to coordinate resource utilization

Requirements

What you’ll need

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

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical assessmentmedical services evaluationresource utilization coordination

Soft Skills

advocacycoordinationsubject matter expertise

Certifications

Active Unrestricted NJ RN LicenseCompact LicenseCCM certification