Hematology/Oncology Case Manager, RN

About the role

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.

Responsibilities

• Identify, collect, process and manage data to perform the Case Management process by utilizing 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.

Qualifications

• 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

Skills and Abilities

• Intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.

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

Pay

Competitive compensation package, including company-paid short and long-term disability, life insurance, and disability premiums for employees.

Schedule

Position Location: 100% remote

What can Imagine360 offer you?

• 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

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Equal Opportunity Employer

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.