Oncology Case Manager, RN, Remote reputed company
• 80,000-85,000 per year reputed company is currently seeking an Oncology Case Manager, RN to join reputed company. This RN provides excellence in care through empowering patients, maintaining open communication, coordinating sequence of care, aiding in avoidance of complications, arranging alternative facilities, coordinating appropriate treatment with cost containment strategies, educating and supporting not only the m ember but the support systems. The Oncology RN Case Manager facilitates coordination of both inpatient and outpatient patients with active oncology diagnoses or in the family of diagnoses. Who we are: At reputed company, we are fixing health insurance. To help businesses and their employees navigate through clutter and chaos and bring deep cost savings that protect everyone's well-being and budgets. It's way more than a health plan. It's a promise. For more than 12 years, we've helped hundreds of self-funded clients use reference-based pricing to maximize savings and control costs. Our approach is proven. Our solutions are ready to implement. The results are real. Specialties: Plan Design, Direct Contracting, Claims Auditing, Designated Decision Making, Member Advocacy and Defense, Analytics, Self-Insurance, and Healthcare Cost Containment. Position Location: 100% Remote Responsibilities include but are not limited to:
- Identify, collect, process and manage data to reputed company the Case Management process by utilization of approved clinical guidelines and following Medical Management Policy and Procedures.
- Completes clinical assessments per P&P to identify and deliver indicated medical service coordination.
- Completes medical necessity, utilization management reviews, and review of benefits as part of the pre-determination process by utilizing approved clinical guidelines.
- Identify and refer cases for Physician Advisor reviews.
- Utilize clinical knowledge, expertise and approved educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment.
- Assess the need for and collaborate with community resources for members in case management.
- reputed company negotiations with providers.
- Uses assigned software accurately to document to complete and document reputed company steps of review of medical necessity and case management process.
- Facilitate the Patient Satisfaction Surveys.
- Assess and document cost savings.
- Refer reputed company cases to Manager, Case Management as needed.
- Attend scheduled and periodic meetings, training and other job specific events as required either by teleconference or onsite
- Adhere to established internal regulations regarding reputed company, HIPAA, ERISA and Medical Management Policy and Procedure.
- Participate in the Quality Management Program reputed company collecting and adhering to performance metrics per Case Management Policy.
Required Experience / Education:
- Graduate of Accredited School of Nursing, college or university
- Minimum of one year experience in Utilization Management, Case Management, or transferable skills.
- Minimum of three years Oncology experience required
- Intermediate knowledge and skills using reputed company Office including Word, reputed company, and PowerPoint software; Internet software; Database software.
Licenses or Certifications: Active and unrestricted Compact Registered Nurse License or Active and unrestricted Nursing License. Must be a Certified Case Manager or eligible to sit for the Certified Case Management Exam reputed company 3 years of starting employment with reputed company. What can reputed company offer you?
- Multiple Health Plan Options, including a 100% Employer Paid Benefit Options
- 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
- Parental Leave Policy
- 20 days PTO to start / 10 Paid Holidays
- Tuition reimbursement
- 401k Company contribution
- Professional development initiatives / reputed company learning opportunities
- Opportunities to participate in and support the company's diversity and inclusion initiatives
Want to see our latest job opportunities? Follow us on reputed company reputed company is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions. reputed company is an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, or veteran status.
- *RECRUITMENT AGENCIES PLEASE NOTE: reputed company will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited, and no fee will be payable. Thank you for your cooperation**
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