RN I, Case Manager

NJM Insurance Group

RN Case Manager responsible for patient assessments and care coordination at Horizon Blue Cross Blue Shield. Evaluating medical services efficiency and advocating for members' continuous care.

Posted 4/14/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $70,500 - $94,395 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
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

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
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

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 evaluationcare coordinationresource utilizationdocumentation standardsproblem solvingvariance analysiscase management principlesutilization management principleshealth care contracts knowledge

Soft Skills

advocacycollaborationcommunicationorganizational skillsinterpersonal skills

Certifications

NJ RN LicenseCompact License