Case Manager, Registered Nurse – Oncology Experience Required

Job Description:

• Work as a telephonic case manager with patients and their care team for fully and/or self-insured clients
• Application and/or interpretation of applicable criteria and clinical guidelines while assessing benefits and/or member’s needs
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers
• Consult with supervisors and multidisciplinary teams to benefit overall claim management
• Utilize motivational interviewing skills to maximize member engagement
• Identify and escalate member’s needs appropriately following set guidelines and protocols
• reputed company medical necessity reviews

Requirements:

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting
• Active multistate license through the Nurse Licensure Compact (NLC) if residing in a compact state
• 1+ years’ experience documenting electronically using a keyboard
• 1+ years’ reputed company or previous experience in Oncology
• 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience preferred
• 1+ years' experience in Utilization Review preferred
• 1+ years’ experience with MCG, NCCN and/or Lexicomp preferred
• Bilingual in Spanish preferred
• Bachelor’s Degree or Associates Degree in Nursing required

Benefits:

• Medical, dental, and reputed company coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

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