Nursing - RN Level 2

Job Title: Nursing - RN Level 2
Job Location: Newark, NJ
Job Duration: 5-6 Months (possibility of extension)
Payrate: $38.00 - $40.00/ hr on w2

Job Summary:

• 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.
• Serves as mentor/trainer to new RN's and other staff as needed.

Responsibilities:

• Assesses patient's clinical need aProductst 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.
• Monitors patient's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Encourages member participation and compliance in the case/disease management program efforts.
• Documents accurately and comprehensively based on the standards of practice and current organization policies.
• Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
• Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes.
• Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes.
• Serves as mentor/trainer to new RN's and other staff as needed.
• Completes other assigned functions as requested by management.

Core Individual Contributor Competencies Personal and professional attributes that are critical to successful performance for Individual Contributors: Customer Focus Accountable Learn Communicate.

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.
• Requires minimum of three (3) years experience in the health care delivery system/industry.
• Requires minimum of two (2) years experience with health care payer experience.

Additional licensing, certifications, registrations:

• Requires an active New Jersey Registered Nurse License.
• Prefers pending or obtained certification in case management, Certified Diabetes Educator (CDE), or other applicable clinical specialties.

Knowledge:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
• Requires knowledge of hospital structures and payment systems.
• Requires working knowledge of case/care/disease management principles.
• Requires working knowledge of operations of utilization, case and/or disease management processes.
• Requires knowledge of health care contracts and benefit eligibility requirements.
• Requires mentoring knowledge on the operations of utilization/case/disease management.

Skills and Abilities:

• Adaptability/Flexibility
• Analytical
• Compassion
• Interpersonal & Client Relationship Skills
• Information/Knowledge Sharing
• Judgment
• Listening
• Planning/Priority Setting
• Problem Solving
• Team Player
• Time Management
• Written/Oral Communication & Organizational Skills