Perform care management within the scope of licensure for members with complex and chronic care needs
Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health care across the care continuum
Conduct assessments to identify individual needs and specific care management plans
Implement care plan actions based on assessments including providing education
Facilitate authorizations/referrals as appropriate within benefits structure
Coordinate internal and external resources to meet identified needs
Monitor and evaluate the effectiveness of care management plans
Interface with Medical Directors and health professionals on care management treatment plans
Assist in problem solving for members and providers related to access to care, vendors, claims, or service issues

BA/BS in a health related field
Minimum of 3 years of clinical experience
Current, unrestricted compact RN license in your home state
Multi-state licensure required if providing services in multiple states
Strong clinical background in hospital setting (e.g., Med Surg, ER, ICU, Critical Care)
Ability to talk, type, and critically think simultaneously
Demonstrates critical thinking skills when interacting with members
Experience with Microsoft Office and/or ability to quickly learn new software
Ability to manage, review, and respond to communications in a timely manner
Excellent collaboration and teamwork skills
Oncology experience preferred

Nurse Case Manager I – Oncology

Key skills