RN II, Case Manager

NJM Insurance Group

RN II Case Manager for Horizon Blue Cross Blue Shield overseeing patient care using established guidelines. Responsible for planning, assessment, and coordination of care for members' health services.

Posted 6/3/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $79,100 - $105,945 per yearWebsite

About the role

Key responsibilities & impact

Responsible for performing RN duties using established guidelines to ensure appropriate level of care.
Plans for the transition to the continuum of care.
Assesses patient's clinical need against established guidelines.
Coordinates and assists in implementation of plan for members.
Monitors patient's medical care activities and outcomes for appropriateness and effectiveness.
Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
Serves as mentor/trainer to new RN's and other staff as needed.
Represents clinical teams within committee meetings.

Requirements

What you’ll need

High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Minimum of two (2) years clinical experience.
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.
Knowledge of hospital structures and payment systems.
Understanding of case/care/disease management principles.

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

RN dutiesclinical assessmentcare coordinationresource utilizationpatient monitoringcase managementdisease management

Soft Skills

advocacymentoringtrainingcommunication

Certifications

NJ RN LicenseCompact LicenseCCM certification