Case Manager, Registered Nurse (Oncology experience required)
Core
Telephonic case manager supporting members across multiple states by applying clinical judgment to reduce risk factors, address complex health/social indicators, and ensure appropriate benefit administration.
Role type
Senior IC Registered Nurse Case Manager (Oncology)
Builds
Cost-effective quality care plans and claim management resolutions for fully/self-insured clients
Domain
US Healthcare / Medical Management
Required skills
Clinical judgment, motivational interviewing, medical necessity review, electronic documentation, regulatory compliance, care plan development, risk factor reduction, multidisciplinary consultation, benefit administration, oncology expertise
Preferred skills
Case management experience, discharge planning, utilization review, MCG/NCCN/Lexicomp proficiency, Spanish language, BSN
Technologies
MCG, NCCN, Lexicomp, Nurse Licensure Compact (NLC)
Responsibilities
Conduct medical necessity reviews, apply clinical guidelines to assess member needs, consult with Medical Directors and supervisors to overcome care barriers, present cases at multidisciplinary conferences, actively reach out to members to guide care, document electronically using a keyboard, identify and escalate member needs per protocols
Seniority
Senior, hands-on IC