Registered Nurse

Job Description

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management.

Responsibilities:

•  Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
•  Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided. 
• Coordinates and assists in implementation of plan for members. Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate.
• Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
•  Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.

Qualifications

Education/Experience:

•  Requires an associate’s or bachelor’s degree (or higher) in nursing and/or a health related field OR accredited diploma nursing school.
  
•  Requires a minimum of two (2) years clinical experience.

Additional licensing, certifications, registrations:

• Requires an active New Jersey Registered Nurse License.
  

Knowledge:

• Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications.
• Prefers working knowledge of case/care management principles.
• Prefers working knowledge of principles of utilization management.
•  Prefers basic knowledge of health care contracts and benefit eligibility requirements.
• Prefers knowledge of hospital structures and payment systems.

Additional Information

All your information will be kept confidential according to EEO guidelines.