Perform RN duties using established guidelines to ensure appropriate level of care
Assess patient's clinical needs against established guidelines
Evaluate the necessity, appropriateness and efficiency of medical services
Coordinate and assist in the implementation of care plans for members
Monitor and coordinate services rendered outside of the network
Advocate for members and families through the healthcare process
Document accurately based on standards of practice and organization policies

High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Minimum of two (2) years clinical experience
Minimum of two (2) years’ experience with health care payer experience
Active Unrestricted NJ RN License or active Compact License Required
CCM certification preferred (for Clinical Advocate roles)
Proficient in personal computers and supporting software in a Windows environment, including MS Office products
Knowledge of hospital structures and payment systems
Working knowledge of case/care/disease management principles and processes

RN II Case Manager – Pediatric, Oncology

About this role