RN II – Primary Nurse Care

NJM Insurance Group

RN II providing primary case management for primary nurse population at Horizon BCBSNJ. Engaging high-risk members in preventive care and advocating for appropriate resources and services.

Posted 7/14/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $79,100 - $105,945 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment, care coordination, and case management, ensuring high-quality, cost-effective care aligned with established guidelines. Proficient in collaborating with multidisciplinary teams and advocating for member needs throughout the continuum of care.

Highest-signal resume keywords

Active Unrestricted RN LicenseClinical Experience in Acute and Chronic ConditionsKnowledge of Case/Care/Disease Management PrinciplesExperience in Health Care Delivery SystemProficiency in MS Office Products

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare CoordinationCase ManagementUtilization ManagementHealth Care Contracts KnowledgeDocumentation StandardsQuality Improvement ParticipationProblem SolvingResource Utilization EvaluationMember Advocacy

Soft Skills

CommunicationCollaborationMentoringInterpersonal SkillsAnalytical Thinking

Tools & Technologies

Windows Based EnvironmentMS Office ProductsMicrosoft OutlookIntranet ApplicationsInternet Applications

Certifications & Qualifications

RN LicenseNJ LicenseCompact LicenseValid Driver's License

Industry Keywords

Health Care Delivery SystemUtilization ManagementChronic ConditionsAcute ConditionsSelf-ManagementContinuum of CareCost-Effective CareQuality ImprovementMember ComplianceFiscal Accountability

About the role

Key responsibilities & impact

Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure
Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider
Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs
Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness
Coordinates with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome
Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care including transitional care
Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness
Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided
Encourages member participation and compliance in the case/disease management program efforts
Documents accurately and comprehensively based on the standards of practice and current organization policies
Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care
Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes
Serves as mentor/trainer to new RN's and other staff as needed
Presents clinical cases during audits conducted by external review organizations
Performs other duties as assigned by management.

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
Experience with both acute and chronic conditions preferred
Requires a minimum of three (3) years' experience in the health care delivery system/industry
Experience with health care payer experience strongly preferred
Active Unrestricted RN License Required; NJ License required and/or Compact License
Requires a valid Driver's License and Insurance
Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook
Prefers knowledge in the use of intranet and internet applications
Requires working knowledge of case/care/disease management principles
Requires working knowledge of operations of utilization, case and/or disease management processes
Requires working knowledge of principles of utilization management
Requires basic knowledge of health care contracts and benefit eligibility requirements
Requires knowledge of hospital structures and payment systems
Prefers understanding of fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.

Benefits

Comp & perks

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