RN II, Field Based

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Evaluates the clinical needs of members against established guidelines and standards to ensure that services provided are medically suitable for their needs.

• Assesses the necessity, appropriateness, and efficiency of the services offered.

• Develops, coordinates, and assists in the execution of individualized care plans for members.

• Collaborates with patients, families, physicians, hospitals, and other external stakeholders regarding the appropriateness of care from diagnosis through to outcomes.

• Facilitates the delivery of high-quality, cost-effective care in alignment with clinical practice guidelines established by the plan, addressing the entire continuum of care.

• Monitors the medical care activities of members, regardless of the service site, and evaluates outcomes for appropriateness and effectiveness.

• Acts as an advocate for members and their families across various sites to coordinate resource utilization and assess the services provided.

• Promotes member participation and adherence to the program.

• Accurately documents information and maintains comprehensive records in accordance with standards of practice and current organizational policies.

• Engages with multidisciplinary teams through telecommunication or in-person interactions, striving for continuity and efficiency as members are managed throughout the continuum of care.

• Understands fiscal accountability and its influence on resource utilization, leading to improved self-care outcomes.

• Assesses care effectiveness by problem-solving, analyzing variances, and engaging in quality improvement initiatives to enhance member outcomes.

• Completes additional assigned tasks as directed by management.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• A Bachelor's degree is preferred, or relevant experience may be considered in lieu of a degree.

• A minimum of two (2) years of clinical experience is required.

• An Active and Unrestricted NJ RN License is essential.

• Must be proficient in using personal computers and supporting software in a Windows environment, including MS Office suite (Word, Excel, PowerPoint) and Lotus Notes.

• Familiarity with case and care management principles is required.

• Understanding of utilization management principles is necessary.

• Basic knowledge of healthcare contracts and benefit eligibility requirements is preferred.

• Knowledge of hospital structures and payment systems is also preferred.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision coverage.

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.