RN I, PCA/MDC/DSNP - Field-Based

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🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $70.5k - $94.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

🚘 Automotive

🏥 Healthcare

⚖️ Legal

Automotive • Healthcare • Legal

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Assesses patient's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to members needs and aligned with benefit structure • Evaluates the necessity, appropriateness and efficiency of service provided • Develops, coordinates and assists in implementation of services to meet the needs of the members • Coordinates with patient, 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 • Monitors patient'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 • Refers members to MLTSS when appropriate • Educates members on the availability of SNP if appropriate • 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 • Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes • Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes • Completes other assigned functions as requested by management • Performs duties as assigned by management

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • A minimum of two (2) years clinical experience is preferred • Active Unrestricted NJ RN License Required • Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes • Working knowledge of case/care management principles • 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