RN II – Primary Nurse Care

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Execute RN responsibilities for the Primary Nurse demographic in accordance with established protocols to guarantee the appropriate level of care.

• Strategize transitions to the continuum of care and create member-focused care plans.

• Engage with high-risk members and promote participation in preventive care initiatives and screenings.

• Evaluate members’ clinical requirements against established criteria and benefit frameworks.

• Address gaps in care and guide high-risk members to suitable care settings.

• Assess the necessity, appropriateness, and efficiency of medical services and procedures for both acute and chronic needs.

• Create, coordinate, and assist in implementing personalized care plans while identifying obstacles to self-management and optimal health.

• Collaborate with members, families, physicians, hospitals, and external stakeholders regarding the appropriateness of care.

• Ensure high-quality, cost-effective care throughout the continuum, including transitional care.

• Monitor members’ medical care activities and outcomes for appropriateness and efficacy.

• Advocate for members and their families across various care settings to optimize resource utilization and evaluate services.

• Promote member engagement and adherence in case/disease management programs.

• Maintain accurate and thorough documentation in line with standards and organizational policies.

• Communicate effectively with multidisciplinary teams via phone and/or in person.

• Assess care, analyze discrepancies, and take part in quality improvement initiatives.

• Mentor and train new RNs and other staff as required.

• Present clinical cases during audits performed by external review organizations.

• Carry out additional tasks as assigned by management.

• Positions associated with ASO accounts may necessitate some travel for on-site availability.

⛳️ Requirements

• High School Diploma/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.

• At least three (3) years of experience in the healthcare delivery system/industry is necessary.

• Experience with both acute and chronic conditions is preferred.

• Strongly preferred: experience with healthcare payer systems.

• Active Unrestricted RN License is required; NJ License and/or Compact License preferred.

• A valid Driver's License and Insurance are required.

• Proficiency in personal computers and software in a Windows environment, including MS Office applications (Word, Excel, PowerPoint) and Microsoft Outlook.

• Familiarity with case/care/disease management principles is necessary.

• Understanding of utilization, case, and/or disease management processes is required.

• Knowledge of utilization management principles is essential.

• Basic understanding of healthcare contracts and eligibility requirements is needed.

• Awareness of hospital structures and payment systems is beneficial.

• Bilingual proficiency is preferred.

• Skills in adaptability/flexibility, analysis, compassion, information sharing, interpersonal and client relationship management, sound decision-making, active listening, organizational planning, problem-solving, teamwork, time management, and both written and oral communication are essential.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement