RN Care Manager-Oncology

Duties and Responsibilities

• 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.
• Complies with all Clinical Management and corporate 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.

Skills

• Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel and the general public.
• Superior clinical process, critical thinking, and problem-solving skills; and ability to handle critical situations.
• Excellent written, oral communication, listening, and organizational skills.
• Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers.
• Ability to use computer system while conversing telephonically.
• Able to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties.
• Able to work autonomously and as part of an interdisciplinary team.
• Demonstrates sound judgment that affirms the rights and responsibilities of Member’s, families, health care professionals and health care organizations.
• Able to operate a personal computer (PC), including proficiency in Microsoft Office Products.

Knowledge

• Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, CMS and ERISA.
• Maintains knowledge of evidence-based guidelines for chronic conditions/care management.
• Knowledge of clinical and managed care principles and operations.
• Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships.
• Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques.

Experience

• At least three (3) years’ recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred.
• Health plan experience preferred.
• Experience related to Oncology highly preferred.
• Experience in health coaching and motivational interviewing techniques preferred.

Education and Certifications

• Registered Nurse with active licensure in home state; additional state’s licensure as needed/required to meet customer needs.
• Certified Case Management certification within 2 years of employment.

Physical Demands

• Ability to travel to provider, facility, employer group and/or member locations using own vehicle, if appropriate.

Benefits

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