RN Care Manager - Oncology

Capital Bluecross • Harrisburg, PA

253d • $27 - $52 • Remote

About The Position

The RN Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome. The care manager will address, medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs. Care Managers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member's optimal health status. The Care Manager is responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral /psychosocial needs.

Requirements

• At least three (3) years' recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred.
• Registered Nurse with active licensure in home state; additional state's licensure as needed/required to meet customer needs.
• Compact RN license and RN - OCN certification preferred.
• Certified Case Management certification within 2 years of employment.

Nice To Haves

• Oncology experience preferred.
• Experience in health coaching and motivational interviewing techniques preferred.
• Health plan experience preferred.

Responsibilities

• Uses a collaborative process and serves as a liaison between the participant, family and significant others, behavioral and medical physician(s) and other members of the treatment team.
• Develops prioritized goals and health actions that assist participants with the implementation of appropriate self-directed care decisions and support improvement in health and self-reliance.
• Advocates for members and families by helping them to coordinate care and navigate resources to reduce barriers and meet healthcare needs.
• Analyzes and evaluates referrals for potential enrollment of Members into Care Management Program(s) using established criteria.
• Conducts assessments to obtain information for a participant-centered plan of care and determination of acuity level, functional status, psychosocial status, and barriers.
• Obtains consent forms necessary for candidates accepted into the Care Management Program.
• Applies established criteria for discharge and discharges the Member from the Care Management Program(s) when the criteria are met.
• Conducts all care management activities, including documentation, in accordance with established departmental policies and procedures.
• Builds relationships with members, their families, and implements interventions that move assigned members toward goals of improved knowledge, self-management, and long term care outcomes of stabilization.
• Identifies and reports quality of care issues in accordance with established departmental policies and procedures.
• Maintains member confidentiality at all times.
• Attends company and departmental meetings and training sessions as required.

Benefits

• Medical, Dental & Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off, Holidays, and Volunteer time off
• Incentive Plan
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Funds, Trusts, and Other Financial Vehicles
• Education Level: Bachelor's degree