Case Manager, Registered Nurse – Oncology Experience Required

This is a fully remote position, open to applicants in Louisiana, +4 more states.

📋 Description

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

• Apply and/or interpret relevant criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while evaluating benefits and/or the needs of members.

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

• Collaborate with supervisors and others to address obstacles in achieving goals and objectives.

• Employ a holistic approach by consulting with clinical colleagues, supervisors, Medical Directors, and/or other programs.

• Implement case management processes in alignment with regulatory requirements and company policies and procedures.

• Apply motivational interviewing techniques to maximize member engagement.

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

• Proactively reach out to members to collaborate and guide their care.

• Conduct medical necessity reviews.

⛳️ Requirements

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

• At least 1 year of experience documenting electronically using a keyboard.

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

• Preferred: At least 1 year of experience in Case Management or discharge planning, nurse navigator, or nurse care coordinator roles.

• Preferred: A minimum of 1 year of experience in Utilization Review.

• Preferred: At least 1 year of familiarity with MCG, NCCN, and/or Lexicomp.

• Bilingual in Spanish is preferred.

• Education: A Bachelor's Degree or an Associate Degree in Nursing is required.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.