RN Case Manager

1 day ago


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

We are seeking a highly skilled and experienced RN Case Manager to join our team at NJM Insurance Group. As a RN Case Manager, you will play a critical role in ensuring that claimants receive high-quality, cost-effective medical care with positive outcomes.

Key Responsibilities:

  • Provide comprehensive case management services to a caseload of approximately 40-50 claimants, including assessment, planning, implementation, and evaluation of individual claimant needs.
  • Collaborate with treatment providers to promote rehabilitation and ensure that treatment plans are evidence-based and aligned with established clinical guidelines.
  • Review clinical information and perform utilization management, concurrent and retrospective, to evaluate treatment plans and manage inpatient length of stay.
  • Maintain accurate records of all communication and interventions, including documentation in the claim system.
  • Participate in medical management initiatives and support projects to improve healthcare outcomes.

Requirements:

  • Registered Nurse (RN) in New Jersey with 3+ years of experience in med-surg and critical care, utilization management review, and 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.

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.

Why Join NJM Insurance Group?

We are proud to be an equal opportunity employer and committed to attracting, retaining, and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.


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