Hematology / Oncology Case Manager, RN

Imagine360 is seeking a Hematology / Oncology Case Manager, RN to join the team!  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 member but the support systems. The Hematology / Oncology RN Case Manager facilitates coordination of both inpatient and outpatient patients with active hematology-oncology diagnoses or in the family of diagnoses. Experience preferred in management of patients who are preparing to undergo or have previously had CAR-T, gene therapy, Bone Marrow / Stem Cell Transplant .

Position Location :   100% remote

Responsibilities include but are not limited to :

• Identify , collect, process and manage data to perform 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 GPA 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.
• Perform negotiations with providers.
• Uses assigned software accurately to document to complete and document all steps of review of medical necessity and case management process.
• Facilitate the Patient Satisfaction Surveys.
• Assess and document cost savings.
• Refer complex 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 Department of Labor, HIPAA, ERISA and Medical Management Policy and Procedure.
• Participate in the Quality Management Program via collecting and adhering to performance metrics per Case Management Policy.

Areas of Responsibility Scope of Practice :

Accurately report :

Required Experience / Education :

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What can Imagine360 offer you?

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Imagine360 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.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.