Case Manager, Registered Nurse

Role Overview

• working intensely as a telephonic case manager with patients and their care team
• application and/or interpretation of applicable criteria and clinical guidelines
• standardized care management plans, polices, procedures and regulatory standards
• assessing benefits and/or member’s needs
• applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers
• consults with supervisor and others in overcoming barriers in meeting goals and objectives
• presents cases at case conferences for multidisciplinary focus
• utilizes case management processes in compliance with regulatory and company policies and procedures
• utilizes motivational interviewing skills to ensure maximum member engagement
• identifies and escalates member’s needs appropriately
• actively reaches out to members to collaborate/guide their care
• perform medical necessity reviews

Requirements

• 5+ years’ experience as a Registered Nurse
• at least 1 year of experience in a hospital setting
• A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC)
• 1+ years’ experience documenting electronically using a keyboard
• 1+ years’ current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience
• 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
• 1+ years' experience in Utilization Review
• 1+ years’ experience with MCG, NCCN and/or Lexicomp
• Bilingual in Spanish preferred

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families