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Case Manager, Registered Nurse – Oncology Experience Required

Job Description:

Work intensely as a telephonic case manager with patients and their care teams for fully and/or self-insured clients
Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards
Assess benefits and member needs to ensure appropriate administration of benefits
Apply clinical judgment and strategies to reduce risk factors and barriers and address complex health and social indicators
Conduct assessments using information from various sources, including co-morbid and multiple diagnoses affecting functionality
Consult with supervisors, clinical colleagues, Medical Directors, and other programs to overcome barriers and meet goals
Present cases at case conferences for multidisciplinary focus and overall claim management
Use case management processes in compliance with regulatory and company policies and procedures
Use motivational interviewing to maximize member engagement and assess health status and needs
Identify and appropriately escalate member needs following guidelines and protocols
Proactively reach out to members to collaborate on and guide their care
Perform medical necessity reviews

Requirements:

5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting
Active multistate RN license through the Nurse Licensure Compact (NLC) for nurses residing in compact states, or individual state-specific RN licenses for each supported state for nurses in non-compact states
1+ years’ experience documenting electronically using a keyboard
1+ years’ current or previous experience in Oncology
Diploma or Associates Degree in Nursing required
1+ years’ Case Management, discharge planning, nurse navigator, or nurse care coordinator experience preferred
Experience transferring patients to lower levels of care preferred
1+ years’ experience in Utilization Review preferred
CCM and/or other URAC recognized accreditation preferred
1+ years’ experience with MCG, NCCN and/or Lexicomp preferred
Bilingual in Spanish preferred
BSN preferred