RN I, Case Manager
NJM Insurance Group
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $70,500 - $94,395 per year
About the role
- Assesses patient's clinical need against established guidelines and/or standards
- Evaluates the necessity, appropriateness and efficiency of medical services and procedures
- Coordinates and assists in implementation of plan for members
- Monitors and coordinates services rendered outside of the network
- Coordinates with patient, family, physician, hospital and other external customers
- Advocates for the member/family among various sites to coordinate resource utilization
- Documents accurately and comprehensively based on standards of practice
- Collaborates with multidisciplinary teams for continuity and efficiency
- Evaluates care by problem solving and analyzing variances.
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 or active Compact License Required
- Prefers proficiency in the use of personal computers and supporting software (MS Office)
- Prefers working knowledge of case/care management principles
- Prefers 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical assessmentmedical services evaluationcare coordinationresource utilizationdocumentation standardsproblem solvingvariance analysiscase management principlesutilization management principleshealth care contracts knowledge
Soft Skills
advocacycollaborationcommunicationorganizational skillsinterpersonal skills
Certifications
NJ RN LicenseCompact License