Hematology/Oncology Case Manager, RN

Imagine360•,

1d•Remote

About The Position

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. This is a 100% remote position.

Requirements

Graduate of Accredited School of Nursing, college or university.
Minimum of two years clinical experience as a Registered Nurse.
Minimum of three years in Hematology experience.
Minimum of two years in Utilization management, Case Management or transferable skills.
Intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.
Must maintain active, current, and unrestricted Registered Nurse license and CEU's as required by the State Board of Nursing.
Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
Must be a Certified Case Manager or eligible to sit for the Certified Case Management Exam within 3 years of starting employment with i360.

Nice To Haves

Experience preferred in management of patients who are preparing to undergo or have previously had CAR-T, gene therapy, Bone Marrow/Stem Cell Transplant.

Responsibilities

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.
Evaluating clinical data.
Assessment and evaluation of the acquired clinical date to assess for appropriateness of treatment based on Imagine360 clinical guidelines.
Coordination of treatment plans, interventions, and outcome measurement.
Rationale for the effects of medication and treatments.
Provide patient education and educational resources.
Accurately report: Administration of medication and treatments, Client response, Contact with other health care team members.
Respect the client's right to privacy by protecting confidential information.
Promote and participate in education and counseling to a participant based on health needs.
Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.

Benefits

Multiple Health plan options
Company paid employee premiums for disability and life insurance
Parental Leave Policy
20 days PTO to start
10 Paid Holidays
Tuition reimbursement
401k Company contribution
Company paid Short & Long term Disability plus Life Insurance
Professional development initiatives / continuous learning opportunities
Opportunities to participate in and support the company's diversity and inclusion initiatives