RN Care Manager - Oncology

About the role

The Care Manager is responsible for coordinating services for members meeting established criteria, focusing on education and self-management to promote quality care and cost-effective outcomes.

Responsibilities

• Serves as a liaison between participants, family, caregivers, providers, and community agencies.
• Develops prioritized goals and health actions to support self-directed care decisions and improve health and self-reliance.
• Advocates for members and families, helping them navigate resources to meet healthcare needs.
• Analyzes and evaluates referrals for potential enrollment into Care Management Programs.
• Conducts assessments to determine acuity levels, functional statuses, psychosocial statuses, and barriers.
• Obtains necessary consent forms for accepted candidates and discharges members from Care Management Programs upon meeting criteria.
• Manages and oversees a caseload of moderate to high-risk members with complex medical, behavioral, and psychosocial needs.
• Documents care management activities in accordance with departmental policies and procedures.
• Complies with clinical management and corporate policies and procedures.
• Maintains member confidentiality at all times.
• Attends company and departmental meetings and training sessions as required.

Qualifications

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

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 appropriately prioritize workload and assignments and perform accurate, detailed, and timely completion of assigned duties.
• Ability to work autonomously and as part of an interdisciplinary team.
• Demonstrates sound judgment that affirms the rights and responsibilities of members, families, health care professionals, and health care organizations.
• Able to operate a personal computer (PC), including proficiency in Microsoft Office Products.

Benefits

Capital Blue Cross offers a comprehensive benefits package including Medical, Dental & Vision coverage, a Retirement Plan, generous time off, an Incentive Plan, Tuition Reimbursement, and more. The salary range displayed has not been adjusted for geographical location and may be modified in the future.

Pay

Salary is influenced by several factors including qualifications, experience, and anticipated contributions to meet business needs, along with internal pay equity and external market-driven rates.

Schedule

Hours and schedule are flexible to accommodate the needs of the position and the member population.

Qualifications

• 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.