Complex Case Manager RN - Oncology (Remote)

Highmark Health
NC, Working at Home, N Carolina
$106.7K a year
Remote
Full-time

Description

JOB SUMMARY

This job has primary ownership and oversight over a specified panel of oncology members that range in health status / severity and clinical needs.

The incumbent assesses health management needs of the assigned member panel and utilizing data / analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member.

The incumbent is responsible for assisting members who have been newly diagnosed with Cancer and / or need assistance with a complex Oncology treatment plan and coordination of care.

They will possess the knowledge and skills to help members with anticipatory guidance (symptom management, managing signs / symptoms as a complication of treatment plan.

The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources.

In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his / her panel that are enrolled in case management.

The incumbent conducts outreach to members enrolled in case management including but is not limited to : developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals.

The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.

ESSENTIAL RESPONSIBILITIES

  • Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and / or triaging members to appropriate resources for additional support.
  • For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members;

care plans include both long and short term goals and plan of regular contacts for re-assessment.

  • Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
  • Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
  • Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and / or ACMA, as required by the organization.
  • Other duties as assigned or requested.

EDUCATION

Required

High School Diploma / GED

Substitutions

None

Preferred

Bachelor's Degree in Nursing

EXPERIENCE

Required

7 years of any combination of clinical, case management and / or disease / condition management experience, provider operations and / or health insurance experience

Preferred

  • Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
  • Experience working with the healthcare needs of diverse populations
  • Understanding of the importance of cultural competency in addressing targeted populations

LICENSES AND CERTIFICATIONS

Required

RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.

Preferred

Certification in Case Management

SKILLS

  • Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
  • Broad knowledge of disease processes
  • Understanding of healthcare costs and the broader healthcare service delivery system
  • Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
  • Excellent interpersonal / consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Ability to work in a high performing team environment that requires flexibility
  • Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
  • Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

LANGUAGE REQUIREMENT (Other than English)

None

TRAVEL REQUIREMENT

0% - 25%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type

Office-Based

Teaches / Trains others regularly

Rarely

Travels regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products / services (Sales employees)

Does Not Apply

Physical Work Site Required

Lifting : up to 10 pounds

Rarely

Lifting : 10 to 25 pounds

Rarely

Lifting : 25 to 50 pounds

Rarely

Pay Range Minimum : $57,700.00

$57,700.00

Pay Range Maximum : $106,700.00

$106,700.00

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation / gender identity or any other category protected by applicable federal, state or local law.

Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation / gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at

30+ days ago
Related jobs
Promoted
Stability Healthcare
Henderson, North Carolina

Stability Healthcare is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Henderson, NC. ...

Promoted
Cynet Health
Henderson, North Carolina

Cynet Health is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Henderson, NC. ...

Promoted
TravelNurseSource
Raleigh, North Carolina

TravelNurseSource is working with Amare Medical Network to find a qualified Case Manager RN in Henderson, North Carolina, 27536!. Case managers work to facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress....

Promoted
RNnetwork
Waynesville, North Carolina

RNnetwork is seeking a travel nurse RN Case Manager, Hospice for a travel nursing job in Waynesville, North Carolina. Posted job title: RN - Case Manager (Hospice) - Varied - Waynesville, N. You can call RNnetwork anytime, day or night for 24/7 access to an RNnetwork manager who will immediately tak...

Promoted
CenterWell Home Health
Raleigh, North Carolina

Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager. Provide admission, case management, and follow-up skilled nursing visits for home health patients. Provide hands-on care, management and evaluation of the care plan and tea...

Promoted
Amedisys
Garner, North Carolina

Are you a highly skilled and compassionate registered nurse (RN) looking for a rewarding career in ho spice as a case manager? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U. Registered Nurse Case Manager. Amedisys is...

Interim HealthCare - Charlotte, NC
Shelby, North Carolina

Interim HealthCare is seeking a full-time Registered Nurse (RN) to join our dedicated team. Valid and current Registered Nurse (RN) license in the state of North Carolina. ...

RNnetwork
Waynesville, North Carolina

RNnetwork is seeking a travel nurse RN Case Manager, Hospice for a travel nursing job in Waynesville, North Carolina. Posted job title: RN - Case Manager (Hospice) - Varied - Waynesville, N. You can call RNnetwork anytime, day or night for 24/7 access to an RNnetwork manager who will immediately tak...

Hospice & Palliative Care Charlotte Region
Charlotte, North Carolina

The Nurse Licensure Compact (NLC) allows a registered nurse (RN) and licensed practical/vocational nurse (LPN/LVN) to have one multistate license in a primary state of residency (the home state) and to practice in other compact states (remote states), while subject to each state’s practice laws and ...

RHA Health Services
Raleigh, North Carolina
Remote

CAP Nurse Case Manager- Primarily Remote. Our ideal CAP Case Manager is an excellent communicator and listener with strong case management experience and who works well as part of an interdisciplinary team providing crisis response. Coordinate services with RN to ensure quality care. RN certificatio...