Case Manager, Registered Nurse (Oncology experience required)
$54,095–$155,538 year
RemoteUnited States
Job Summary
Conduct telephonic case management for fully and/or self-insured clients by applying clinical judgment to reduce risk factors and address complex health indicators. Perform medical necessity reviews and assessments utilizing information from various sources to resolve member issues involving co-morbidities and multiple diagnoses. Collaborate with clinical colleagues, supervisors, and medical directors to overcome barriers in care planning while utilizing motivational interviewing skills to ensure maximum member engagement. Escalate member needs appropriately following set guidelines and protocols, presenting cases at multidisciplinary conferences for overall claim management.
Required Qualifications
- 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting
- A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license
- Nurses residing in non‐compact states must hold an individual, state‐specific RN license for each state they support
- 1+ years' experience documenting electronically using a keyboard
- 1+ years' current or previous experience in Oncology
- Diploma or Associates Degree in Nursing required
Desired Qualifications
- 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
- 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
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