Oncology Care Management Nurse

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Deliver clinical care management, encompassing case management, disease management, and/or care coordination.

• Evaluate, plan, implement, coordinate, monitor, and assess member care.

• Advocate for quality and cost-effective healthcare results.

• Execute case management tasks to identify and fulfill member needs.

• Utilize clinical expertise and judgment to ensure adherence to medical policy, medical necessity guidelines, accepted care standards, and licensure scope.

• Collaborate with physician advisors, internal and external clients, and various departments.

• Address claims, quality of care, member, and provider concerns.

• Recognize issues or necessary changes, propose solutions, and engage in quality improvement initiatives.

• Act as a resource for internal and external clients and respond professionally to inquiries.

• Safeguard the confidentiality of sensitive documents and matters.

• Maintain consistent and precise documentation in accordance with performance standards, corporate objectives, and timelines.

• Organize resources and prioritize tasks to achieve goals and deadlines.

• Monitor and assess the effectiveness of the case management plan and modify plans as necessary.

⛳️ Requirements

• Degree in nursing or health/human services (minimum of Associate's or Bachelor's), or equivalent experience in lieu of a degree.

• At least 3 years of direct clinical care or experience in case management, utilization management, disease management, auditing, or retrospective review.

• Active, unrestricted licensure or certification in a U.S. state or territory permitting independent assessments within the scope of practice.

• RN license is mandatory for medical care management.

• Eligibility for licensure in Idaho, Oregon, Utah, and Washington is required.

• Understanding of health insurance industry trends, technologies, and contractual agreements.

• Basic computer proficiency, including Microsoft Office, Outlook, and internet research.

• Familiarity with healthcare documentation systems.

• Excellent oral, written, interpersonal communication, and customer service abilities.

• Capability to interpret policies and procedures, make informed decisions, and effectively communicate complex subjects.

• Strong organizational and time management skills; ability to independently manage workload.

• Proficient critical thinking and decision-making skills relevant to the role and responsibilities.

• Experience with AI tools and technologies is highly preferred.

• A wired internet connection that is neither satellite nor cellular, with a minimum of 5 Mb upload and 10 Mb download speeds.

• Access to a personal mobile device for Multi-Factor Authentication.

• Successful completion of a background check.

• Must reside within Oregon, Washington, Idaho, or Utah.

🏝️ Benefits

• Competitive salary.

• Bonus opportunities with an 8% bonus target.

• Medical, dental, and vision insurance for employees and eligible family members, including mental health benefits.

• Annual employer contributions to a health savings account.

• Generous paid time off that varies by role and tenure.

• 10 company-paid holidays.

• Leading retirement plan, including company matching on 401(k) contributions.

• Potential discretionary 401(k) contributions based on company performance, with no vesting period.

• Up to 12 weeks of paid parental leave, contingent upon eligibility.

• Award-winning wellness programs that incentivize participation.

• Employee Assistance Fund.

• Commute and parking benefits.

• Options for remote work.

• Wired internet connection and minimum internet speed requirements for remote work options.

• Access to employee resource groups.

• Community outreach programs supported by Cambia.

• Access to a personal mobile device for Multi-Factor Authentication.