Case Manager, Registered Nurse (Oncology experience required)

CVS Health•Work At Home-Texas, NV

1d•$54,095 - $155,538•Remote

About The Position

This is a remote work-from-home role available anywhere in the United States, with virtual training. American Health Holding, Inc. (AHH), a medical management company within Aetna/CVS Health, provides flexible medical management services supporting cost-effective quality care. The Registered Nurse Case Manager works intensively by telephone with patients and their care teams for fully insured and/or self-insured clients. The role uses clinical guidelines, case management practices, and a holistic approach to assess members’ needs, support appropriate benefits administration, and help members address barriers to care. The position requires oncology experience and includes medical necessity reviews. The position is full time, with 40 anticipated weekly hours.

Requirements

At least 5 years of experience as a Registered Nurse, including at least 1 year in a hospital setting.
An active multistate RN license through the Nurse Licensure Compact (NLC) if residing in a compact state; nurses residing in non-compact states must hold an individual RN license for each state supported.
At least 1 year of experience documenting electronically using a keyboard.
At least 1 year of current or previous oncology experience.
Diploma or associate degree in nursing required.

Nice To Haves

At least 1 year of case management, discharge planning, nurse navigator, or nurse care coordinator experience, including experience transferring patients to lower levels of care.
At least 1 year of Utilization Review experience.
CCM and/or other URAC-recognized accreditation.
At least 1 year of experience with MCG, NCCN, and/or Lexicomp.
Bilingual in Spanish.
BSN.

Responsibilities

Work as a telephonic case manager with patients and their care teams for fully insured and/or self-insured clients.
Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards when assessing benefits and member needs.
Use clinical judgment to develop strategies that reduce risk factors and barriers and address complex health and social indicators that affect care planning and resolution of member issues.
Assess information from various sources and consider all conditions, including comorbidities and multiple diagnoses that affect functionality.
Consult with supervisors and others to overcome barriers to meeting goals and objectives, and present cases at multidisciplinary case conferences.
Consult with clinical colleagues, supervisors, Medical Directors, and other programs to address barriers and meet goals and objectives using a holistic approach.
Use case management processes in compliance with regulatory and company policies and procedures.
Use motivational interviewing to engage members and understand their health status and needs.
Identify and escalate member needs according to established guidelines and protocols.
Proactively reach out to members to collaborate on and guide their care.
Perform medical necessity reviews.