working intensely 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, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
Applies clinical judgment to reduce risk factors, barriers, and address complex health and social indicators.
Assessments utilize information from various sources including co-morbid conditions.
Consults with supervisor and others to overcome barriers in meeting goals and objectives.
Using a holistic approach, consults with clinical colleagues and Medical Directors to meet goals.
Utilizes motivational interviewing skills to ensure maximum member engagement.
Identifies and escalates member’s needs appropriately.

5+ years’ experience as a Registered Nurse, including at least 1 year 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), allowing practice across participating states with one license.
Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support
1+ years’ experience documenting electronically using a keyboard.
1+ years’ current or previous experience in Oncology.
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 preferred.
1+ years' experience in Utilization Review.
CCM and/or other URAC recognized accreditation preferred.
1+ years’ experience with MCG, NCCN and/or Lexicomp preferred.
Bilingual in Spanish preferred.
Bachelor’s Degree or Associates Degree in Nursing required.

Case Manager, Registered Nurse – Oncology Experience Required

About this role