REGISTERED NURSES

If you’re a skilled nurse and you’re looking to make a difference, there’s no place quite like ours. Here, applying good judgment and clinical knowledge can improve outcomes for over three million—the number of people in the state of New Jersey who’ve chosen us as their health insurance plan. And while you’re striving to make life better for others, you’ll be enjoying schedules, a work setting, and benefits that enrich your own life. Explore these opportunities to impact the customer experience, service accessibility and plan efficiency—and make healthcare more satisfying for everyone.• Concurrent Review Coordinator •Coordinate the concurrent review of inpatient care, via telephone and site visits—to ensure medical necessity, and appropriate levels of care and length of stay. Involves discharge planning, monitoring the allocation of resources, confirming member eligibility/benefits, coordinating/tracking out-of-network patient services, and presenting cases to UM, QA or Appeals. Requires two or three years of nursing experience and some work experience in utilization or a service-quality initiative• Prior Authorization Coordinator •Be responsible for efficiently executing pre-admission and utilization management processes, while coordinating benefits for members, providers and employer groups. Also involves some of the duties shown above. Must have two years of clinical or home care experience and two additional years in a complex managed care or health system environment. • Care Managers/Case Specialists •Inspire members towards greater self-management of disease—chiefly by providing education and counseling. You will also be key in arranging patient access to quality care services. Must have three to five years of nursing experience in a clinical or home care setting. Certified Case Manager a big plus. Candidates for the above three positions must possess: current NJ RN License familiarity with utilization management processes working knowledge of managed care principles, contracting and benefits keen communication, organizational, analytical and problem-solving skills a health-related bachelor’s degree is desired We offer competitive salaries, a dynamic work environment,and a comprehensive benefits package.