RN Care Manager – Oncology

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Facilitate services for members who meet specified criteria, focusing on education, self-management, quality care, and cost-effective outcomes.

• Evaluate member requirements, explore service and resource alternatives, create and execute care plans, coordinate resources, track progress, assess status, and discharge members.

• Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder requirements.

• Offer counseling and connect members to community, local, state, and other programs.

• Collaborate with caregivers, healthcare providers, community organizations, behavioral health teams, and other resources.

• Manage and supervise a caseload of members with moderate to high risk, presenting complex medical, behavioral, and psychosocial needs.

• Act as a liaison among participants, families, physicians, and treatment team members.

• Establish prioritized goals and health actions to promote self-directed care and enhance health outcomes.

• Advocate for members and their families by coordinating care and facilitating access to resources.

• Analyze referrals for potential enrollment and perform participant-centered assessments.

• Secure necessary consent forms and implement discharge criteria.

• Record care management activities in accordance with established policies and procedures.

• Cultivate relationships and implement interventions that promote knowledge, self-management, and stabilization.

• Identify and report issues related to quality of care.

• Ensure member confidentiality is maintained.

• Participate in company and departmental meetings as well as training sessions.

⛳️ Requirements

• Registered Nurse with active licensure in the home state.

• Additional state licensure as required to fulfill customer needs.

• Certified Case Management certification to be obtained within 2 years of employment.

• A minimum of three years of recent, relevant experience.

• At least three years of clinical experience in social work counseling involving complex psychiatric and substance abuse or substance use disorder treatment, or an equivalent combination of education and experience.

• Experience in care management, home health, medical/surgical behavioral health, and/or critical care is preferred.

• Health plan experience is preferred.

• Oncology experience is preferred.

• Experience in health coaching and motivational interviewing is preferred.

• Familiarity with NCQA, DMAA, CMSA, Act 68, CMS, and ERISA standards.

• Understanding of evidence-based guidelines for chronic conditions and care management.

• Knowledge of clinical and managed care principles and operations.

• Awareness of medical treatment modalities and best practice guidelines.

• Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques.

• Excellent communication, clinical process, critical thinking, problem-solving, written, oral, listening, and organizational skills.

• Ability to operate a computer system while conversing on the telephone.

• Strong customer service abilities, with tact and diplomacy.

• Capability to prioritize workload and complete tasks accurately and on time.

• Ability to work independently and as part of an interdisciplinary team.

• Sound judgment regarding the rights and responsibilities of members and healthcare stakeholders.

• Proficiency in Microsoft Office applications.

• Availability to travel to provider, facility, employer group, and/or member locations using a personal vehicle, if necessary.

🏝️ Benefits

• Medical, Dental & Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible work environment.

• Training and continuing education opportunities.

• Opportunities to volunteer in the community.