RN II - Primary Nurse Care

About the Role

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure an appropriate level of care, as well as planning for the transition to the continuum of care and developing a member‑centric plan of care. Primary Nurses will outreach to high‑risk members and engage them in preventative care opportunities and screenings when possible. The role also includes performing care management duties assigned by management and serving as a mentor/trainer to new RNs and other staff as needed.

Positions involving ASO accounts may require some travel for on‑site availability.

• Assess members’ clinical needs against established guidelines and/or standards to ensure services are medically appropriate and aligned with the benefit structure.
• Facilitate responses to gaps in care and identify high‑risk members for appropriate settings of care, including annual wellness visits and collaboration with treating providers.
• Evaluate the necessity, appropriateness, and efficiency of medical services and procedures for both acute and chronic health needs.
• Develop, coordinate, and assist in implementing individualized plans of care, identifying barriers to self‑management and optimal wellness.
• Coordinate with members, family, physicians, hospitals, and external customers on care appropriateness from diagnosis to outcome.
• Coordinate delivery of high‑quality, cost‑effective care supported by clinical practice guidelines across the continuum of care, including transitional care.
• Monitor members’ medical care activities and outcomes for appropriateness and effectiveness.
• Advocate for members/families among various sites to coordinate resource utilization and evaluate services provided.
• Encourage member participation and compliance in case/disease management program efforts.
• Document accurately and comprehensively following standards of practice and organizational policies.
• Interact and communicate with multidisciplinary teams telephonically or in person to ensure continuity and efficiency of care.
• Evaluate care by problem‑solving, analyzing variances, and participating in quality improvement programs to enhance member outcomes.
• Serve as mentor/trainer to new RNs and staff as needed.
• Present clinical cases during audits conducted by external review organizations.
• Perform other duties assigned by management.

• High School Diploma or GED (required). Bachelor’s degree preferred or relevant experience in lieu of a degree.
• Minimum of 2 years of clinical experience; experience with both acute and chronic conditions preferred.
• Minimum of 3 years in the health care delivery system/industry.
• Health care payer experience strongly preferred.
• Active, unrestricted RN license required; NJ license required and/or a Compact license.
• Valid driver’s license and insurance.

• Active Unrestricted RN License – required.
• New Jersey License required; optionally a Compact License.
• Valid driver’s license and insurance.

• Proficiency with personal computers and supporting software in a Windows environment (MS Office, Outlook).
• Knowledge of intranet and internet applications (preferred).
• Working knowledge of case/care/disease management principles and processes.
• Working knowledge of utilization management principles.
• Basic knowledge of health care contracts and benefit eligibility requirements.
• Knowledge of hospital structures and payment systems.
• Understanding of fiscal accountability and its impact on resource utilization and self‑care outcomes (preferred).

• Bi‑lingual proficiency preferred.
• Adaptability/Flexibility.
• Analytical.
• Compassion.
• Information/Knowledge Sharing.
• Interpersonal & Client Relationship.
• Sound decision making.
• Active listening.
• Organization, Planning, & Priority Setting.
• Problem Solving/Critical Thinking.
• Team Player.
• Time Management.
• Written/Oral Communications.

You’ll do meaningful work that directly improves lives, while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe when our people thrive, our communities do too.

$79,100 –…