Field RN Case Manager

Morris County NJ

Atlantic Group is partnering with a large local Insurance client currently seeking a Field RN Case Manager in Parsippany, NJ to assure that claimants receive high quality, cost-effective medical care with positive outcomes.   This role will involve approximately 30% travel.

 

Responsibilities

 

  • Review clinical information and perform utilization management, concurrent and retrospective, utilizing established evidence-based clinical guidelines to evaluate treatment plans and/or manage inpatient length of stay
  • Review precertification/preauthorization requests for medical necessity and ensure that treatment is supported by treatment guidelines, medical policies, and/or medical evidence
  • Refer cases that don’t meet established guidelines for medical necessity to Medical Director for additional review
  • Provide Case Management services to a caseload of approximately 50-80 claimants, which includes: comprehensive assessment, planning, implementation and overall evaluation of individual claimant needs

 

Requirements

 

  • RN diploma required, BSN preferred
  • Registered Nurse (RN) in New Jersey
  • 3 + years of experience preferred in: Med-Surg and critical care and clinical nursing, Utilization Management Review/Hospital concurrent reviews, and/or Hospital Bill Auditing for inappropriate charges, denials and uncertified days
  • Experience with PIP (personally injury protection), Workers Compensation, medical record reviews, medical terminology, appropriate level of health care, treatment modalities and health care delivery systems
  • Experience with Microsoft Office products and database programs, data analysis and data management proficiency
  • Knowledge of professional nursing principles, clinical practice guidelines, and clinical interventions
  • Knowledge of MCG/Millman, Official Disability Guidelines (ODG) and/or other evidence-based guidelines databases
  • Competence in negotiation, quality assurance, case management outcomes, and data analysis
  • Up to 30% travel required

 

 

 

 

Note: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, we will keep your resume on file for future opportunities and may contact you for further discussion.

Date Posted 3/25/2020
Salary $80,000 - $90,000






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