Case Manager, Registered Nurse – Oncology Experience Required

Role Overview

• working intensely as a telephonic case manager with patients and their care team
• Application and/or interpretation of applicable criteria and clinical guidelines
• 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
• Addressing complex health and social indicators which impact care planning and resolution of member issues
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives
• Presents cases at case conferences for multidisciplinary focus
• Utilizes motivational interviewing skills to ensure maximum member engagement
• Identify and escalate member’s needs appropriately following set guidelines and protocols
• Perform medical necessity reviews.

Requirements

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting
• 1+ years’ experience documenting electronically using a keyboard
• 1+ years’ current or previous experience in Oncology
• A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC)
• Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support
• 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience is preferred
• 1+ years' experience in Utilization Review
• CCM and/or other URAC recognized accreditation preferred
• 1+ years’ experience with MCG, NCCN and/or Lexicomp
• Bilingual in Spanish preferred.
• Bachelors Degree Education Diploma or Associates Degree in Nursing required.

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs