Oncology Case Manager, RN

About the role

Imagine360 is seeking an 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 Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures
• Completes clinical assessments per P&P to identify and deliver indicated medical service coordination
• Manage the transplant cases, cases that may lead toward organ transplant, and complex disease cases
• Utilize clinical knowledge, expertise, and 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
• Uses assigned software accurately to document to complete and document all steps of review of medical necessity and case management process, including time slips
• Facilitate the Patient Satisfaction Surveys
• Assess for cost savings and document the cost saving in assigned software
• Appropriately refer complex cases to Supervisor, Case Management, or designee
• Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards
• Consistently exercises discretion and judgment to analyze, interpret, make deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case
• Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices
• Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate
• Executes activities or interventions to achieve the goals in the plan
• Organizes, integrates, and modifies the resources needed to reach the goals in the plan
• Makes sure all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness
• Researches medical procedures, treatments, and coding when necessary
• Measures the outcomes of interventions
• Adheres to practicing the care management core components throughout the continuum of care:Case Management Concepts Case Management Principles and Strategies Psychosocial and Support Systems Healthcare Management and Delivery Healthcare Reimbursement Vocational Concepts and Strategies

Qualifications

• A nursing degree from an accredited college, university, or school of nursing
• Minimum of two years in Oncology experience required
• Minimum of one year experience in Utilization Management, Case Management, or transferable skills

Skills and Abilities

• Ability to work independently in a home office environment
• Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet
• Ability to resolve problems independently and demonstrate ability to multi-task
• Strong written, oral, and telephonic communication skills
• Strong presentation skills
• Ability to demonstrate a commitment to building new skills and fostering a positive work environment
• Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented
• Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines
• Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations

License and Certifications

• Current, active, and unrestricted compact Registered Nurse license
• Must maintain 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