RN Case Manager

1 week ago


Trenton, New Jersey, United States NJM Insurance Group Full time

NJM Insurance Group is seeking a skilled RN Case Manager to ensure that claimants receive high-quality, cost-effective medical care with positive outcomes. The ideal candidate will be results-driven and possess excellent relationship management skills, including the ability to influence and/or mentor others with varying levels of experience.

This role will require some travel. The successful candidate will be responsible for providing case management services to a caseload of approximately 40-50 claimants, which includes comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs.

Key Responsibilities:

  • Collaborate with treatment providers to promote rehabilitation and ensure that treatment plans are supported by evidence-based clinical guidelines.
  • Review clinical information and perform utilization management, concurrent and retrospective, to evaluate treatment plans and/or manage inpatient length of stay.
  • Maintain accurate records of all communication and interventions, including documentation in the claim system.
  • Participate and support projects around medical management initiatives and monitor all utilization reports to ensure compliance and identify trends.
  • Assist with preparation of reports, as needed, and support company and departmental Quality Assurance/Quality Improvement initiatives.

Required Qualifications and Experience:

  • Registered Nurse (RN) in New Jersey with 3+ years of experience in Med-Surg and critical care, utilization management review, and/or hospital concurrent reviews.
  • Knowledge of professional nursing principles, clinical practice guidelines, and clinical interventions.
  • Excellent relationship management skills, including the ability to influence and/or mentor others with varying levels of experience.
  • Demonstrated ability to problem-solve and resolve complex, multifaceted, and emotionally-charged situations.
  • Ability to travel within NJ and strong organizational, task prioritization, and delegation skills.

Preferred Qualifications:

  • Experience in Workers Compensation and/or PIP.
  • BSN from an accredited school of nursing.
  • Knowledge of MCG/Millman, Official Disability Guidelines (ODG), and/or other evidence-based guidelines databases.

NJM Insurance Group is an equal opportunity employer and is committed to attracting, retaining, and promoting a diverse and inclusive workforce.


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