RN II – Primary Nurse Care, Case Management

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🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $79.1k - $105.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

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

• Assess 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 • Facilitate response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider • Evaluate the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs • Develop, coordinate and assist in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness • Coordinate with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome • Coordinate 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 • Monitor member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness • Advocate for the member/family among various sites to coordinate resource utilization and evaluation of services provided • Encourage member participation and compliance in the case/disease management program efforts • Document accurately and comprehensively based on the standards of practice and current organization policies • Interact and communicate with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care • Evaluate care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes • Serve as mentor/trainer to new RN's and other staff as needed • Present clinical cases during audits conducted by external review organizations • Perform other duties as assigned by management

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Minimum of two (2) years clinical experience • Experience with both acute and chronic conditions preferred • Minimum of three (3) years' experience in the health care delivery system/industry • 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 • 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 • Working knowledge of case/care/disease management principles • Working knowledge of operations of utilization, case and/or disease management processes • Requires working knowledge of principles of utilization management • Basic knowledge of health care contracts and benefit eligibility requirements • 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