Case Manager, Registered Nurse – Oncology Experience Required

📋 Description

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

• Apply and/or interpret relevant criteria and clinical guidelines while evaluating benefits and/or the needs of members.

• Utilize clinical judgment to implement strategies aimed at minimizing risk factors and overcoming barriers.

• Consult with supervisors and multidisciplinary teams to enhance overall claim management.

• Employ motivational interviewing techniques to maximize engagement with members.

• Recognize and appropriately escalate member needs in accordance with established guidelines and protocols.

• Conduct reviews to determine medical necessity.

⛳️ Requirements

• Over 5 years of experience as a Registered Nurse, including a minimum of 1 year in a hospital environment.

• Possession of an active multistate license via the Nurse Licensure Compact (NLC) if residing in a compact state.

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

• Minimum of 1 year of current or previous experience in Oncology.

• Preferred: 1+ years of experience in Case Management or discharge planning, nurse navigator, or nurse care coordinator roles.

• Preferred: 1+ years’ experience in Utilization Review.

• Preferred: 1+ years’ experience with MCG, NCCN, and/or Lexicomp.

• Bilingual in Spanish is preferred.

• A Bachelor’s Degree or an Associate Degree in Nursing is required.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• Paid time off for personal and family needs.

• Options for retirement savings.

• Access to wellness programs.

• Additional resources available based on eligibility.