RN II, Case Manager – Pediatrics

NJM Insurance Group

RN II/ Case Manager for Pediatrics at Horizon Blue Cross Blue Shield supporting care management and transitions. Focusing on member advocacy and clinical engagement in a remote role.

Posted 6/24/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $79,100 - $105,945 per yearWebsite

About the role

Key responsibilities & impact

Performs 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
Evaluates the necessity, appropriateness and efficiency of medical services
Coordinates and assists in the implementation of care plans for members
Monitors and coordinates services rendered outside of the network
Advocates for members among various sites to coordinate resource utilization
Documents accurately based on the standards of practice
Acts as a subject matter expert for projects and committees
Serves as mentor/trainer to new RN's and staff as needed

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 required
Minimum of two (2) years’ experience with health care payer experience required
Active Unrestricted NJ RN License or active Compact License Required
CCM certification preferred for Clinical Advocate roles
Proficient in the use of personal computers and MS Office products
Knowledgeable in hospital structures and payment systems
Working knowledge of case/care/disease management principles and processes
Must be able to work collaboratively in a team environment

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 assessmentcare planningresource utilizationdocumentation standardscase managementcare managementdisease managementhealth care payer experienceclinical experience

Soft Skills

advocacymentoringcollaborationcommunication

Certifications

NJ RN LicenseCompact LicenseCCM certification