Case Manager, Registered Nurse – Oncology Experience Required

Job Description: • Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues • Consult with supervisor and others in overcoming barriers in meeting goals and objectives • Present cases at case conferences for multidisciplinary focus to benefit overall claim management • Use a holistic approach, consulting with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives • Utilize case management processes in compliance with regulatory and company policies and procedures • Utilize motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs • Identify and escalate member’s needs appropriately following set guidelines and protocols • Actively reach out to members to collaborate/guide their care • Perform medical necessity reviews Requirements: • 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting • A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privilege and can be licensed in all non-compact states • 1+ years’ experience documenting electronically using a keyboard • 1+ years’ current or previous experience in Oncology • 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience 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 • Bachelor's Degree Education Diploma or Associates Degree in Nursing required Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access and many other benefits depending on eligibility Apply tot his job Apply To this Job