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Oncology Case Manager RN

4 weeks ago

Jefferson City, Missouri, United States CVS Health Full time

Job Summary

This is a remote work from home role anywhere in the US with virtual training. The successful candidate will work as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

Key Responsibilities

  • Apply clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
  • Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
  • Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
  • Utilizes case management processes in compliance with regulatory and company policies and procedures.
  • Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
  • Identifies and escalates member's needs appropriately following set guidelines and protocols.
  • Need to actively reach out to members to collaborate/guide their care.
  • Perform medical necessity reviews.

Requirements

  • 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty.
  • A Registered Nurse that holds an unrestricted license in their state of residence, and will to get a multi-state/compact privileges and can be licensed in all non-compact states.
  • 1+ years' experience documenting electronically using keyboard and multiple computer screens as well as free form text with good typing skills.
  • 1+ years' current or previous experience in Oncology.

Preferred Qualifications

  • 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.
  • CCM and/or other URAC recognized accreditation preferred.
  • 1+ years' experience with MCG, NCCN and/or Lexicomp.
  • Bilingual preferably Spanish.

Education

  • Diploma or Associates Degree in Nursing or higher.

Benefits

  • The Company offers a full range of medical, dental, and vision benefits.
  • Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.
  • The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.
  • CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
  • As for time off, Company employees enjoy Paid Time Off (''PTO'') or vacation pay, as well as paid holidays throughout the calendar year.