RN II, Care Manager – Oncology

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

📋 Description

• Execute RN responsibilities following established protocols to guarantee an appropriate level of care and facilitate transitions within the continuum of care.

• Evaluate patients' clinical needs in accordance with established guidelines and benchmarks for suitable inpatient care and duration of stay.

• Assess the necessity, relevance, and efficiency of medical services and procedures.

• Collaborate with and assist in the implementation of member care plans.

• Oversee and coordinate out-of-network and out-of-area services, negotiating fees when necessary.

• Liaise with patients, families, physicians, hospitals, and external stakeholders to ensure suitable care from diagnosis to outcome.

• Facilitate high-quality, cost-effective care throughout the continuum by utilizing clinical practice guidelines.

• Monitor medical care activities and outcomes to ensure appropriateness and effectiveness.

• Advocate for members and families across various care sites to optimize resource utilization and assess services.

• Promote member engagement and adherence to case/disease management programs.

• Maintain accurate and thorough documentation in line with practice standards and organizational policies.

• Communicate with multidisciplinary teams both telephonically and in person to enhance continuity and efficiency.

• Assess care, analyze discrepancies, and engage in quality improvement initiatives.

• Mentor and train new RNs and other personnel.

• Act as a subject matter expert for projects and user acceptance testing of the medical management system.

• Take on leadership responsibilities in the absence of the team lead.

• Represent clinical teams and present findings at committee meetings.

• Reach out to members requiring Clinical Advocate services.

• Apply critical thinking and clinical expertise to optimize outcomes in a dynamic environment.

• Establish trusting relationships using Motivational Interviewing techniques.

• Clearly explain ASO client employer-sponsored benefits, claims, care coordination, and complex needs in accessible language.

• Advocate for members throughout their healthcare journeys, emphasizing comprehensive support that addresses physical, mental, and emotional well-being.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• A Bachelor's degree is preferred, or relevant experience may be considered in lieu of a degree.

• A minimum of two (2) years of clinical experience is required.

• At least two (2) years of experience with healthcare payer systems is essential.

• An active Unrestricted NJ RN License or an active Compact License is required.

• CCM certification is preferred.

• Proficiency in personal computers and associated software in a Windows environment, including MS Office applications (Word, Excel, PowerPoint, and Outlook).

• Familiarity with intranet and internet applications.

• Understanding of hospital structures and payment systems.

• Practical knowledge of case/care/disease management principles.

• Familiarity with utilization, case, and/or disease management processes.

• Awareness of healthcare contracts and benefit eligibility criteria.

• Mentoring experience in utilization/case/disease management operations.

• Willingness to work a specified number of weekends and holidays based on departmental needs.

• Ability to work an 8- or 10-hour shift from Monday to Friday, with hours ranging from 8 am to 11 pm.

• Excellent communication and organizational abilities, along with a high tolerance for ambiguity.

• Capacity to comprehend and relay members' benefits, claims, and coordination information.

• Ability to thrive in a collaborative team setting.

• Strong analytical, critical thinking, and interpersonal skills.

• Exceptional multi-channel communication and interpersonal abilities, including the capacity to clarify complex ideas with empathy.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement