Case Manager, Registered Nurse – Oncology Experience Required

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Engage actively as a telephonic case manager with patients and their care teams for both fully and/or self-insured clients.

• Implement and interpret relevant criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards.

• Evaluate benefits and the needs of members to ensure effective administration of benefits.

• Utilize clinical judgment to mitigate risk factors and barriers, while addressing complex health and social determinants that influence care planning.

• Conduct assessments by gathering information from various sources, including co-morbidities and multiple diagnoses impacting functionality.

• Collaborate with supervisors, clinical colleagues, Medical Directors, and other programs to resolve obstacles.

• Present cases at multidisciplinary case conferences to enhance overall claim management.

• Employ case management processes in accordance with regulatory and company policies.

• Apply motivational interviewing techniques to enhance member engagement and evaluate health status and needs.

• Recognize and appropriately escalate member needs following established guidelines and protocols.

• Proactively reach out to members to collaborate on and direct their care.

• Conduct medical necessity reviews.

⛳️ Requirements

• A minimum of 5 years' experience as a Registered Nurse, including at least 1 year in a hospital environment.

• An active multistate license through the Nurse Licensure Compact (NLC) for nurses residing in compact states, or a specific state RN license for each state supported for nurses in non-compact states.

• At least 1 year of experience with electronic documentation using a keyboard.

• A minimum of 1 year of current or prior experience in Oncology.

• Preferred experience of 1 year in Case Management, discharge planning, nurse navigation, or nurse care coordination.

• Preferred experience of 1 year in Utilization Review.

• CCM and/or other URAC recognized accreditation is preferred.

• Preferred experience of 1 year with MCG, NCCN, or Lexicomp.

• Bilingual in Spanish is preferred.

• A BSN is preferred.

• A Diploma or Associate's Degree in Nursing is required.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Virtual training.