RN II - Oncology Case Manager-REMOTE BASED

About the role

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Serves as mentor/trainer to new RN's and other staff as needed. Subject matter expert for the various projects and committees as needed.

Responsibilities

• Affirms patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay.
• Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
• Captures and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate.
• Coordinates with patient, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome.
• Monitors and coordinates services rendered outside of the network, as well as outside the local area, and negotiate fees for such services as appropriate.
• Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
• Maintains accurate and comprehensive documentation based on the standards of practice and current organization policies.
• Communicates effectively with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care.
• Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided.
• Serves as mentor/trainer to new RN's and other staff as needed.
• Acts as subject matter expert for respective area for projects.
• May assume leadership type activities in team lead absence.
• Represents clinical teams within committee meetings.
• Presents reports required at committee meetings.
• Serves as subject matter expert for user acceptance testing for medical management system.

Requirements

High School Diploma/GED required. Bachelor degree preferred or relevant experience in lieu of degree. Requires a minimum of two (2) years clinical experience. Requires minimum of two (2) years’ experience with health care payer experience. Utilization Management Only(Utilization Inpatient Case Management does NOT apply to RN II role within HCS): RN’s are required to work a specified number of weekends and holidays to meet Regulatory and Accrediting body standards. Additional Licensing, Certifications, Registrations: Active Unrestricted NJ RN License or active Compact License Required.

Qualifications

Knowledge: Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint and Outlook). Should be knowledgeable in the use of intranet and internet applications. Requires knowledge of hospital structures and payment systems. Requires working knowledge of case/care/disease management principles. Requires working knowledge of operations of utilization, case and/or disease management processes. Requires knowledge of health care contracts and benefit eligibility requirements. Requires mentoring knowledge on the operations of utilization/case/disease management.

Skills and Abilities

• Adaptability/Flexibility
• Analytical
• Compassion
• Interpersonal & Client Relationship Skills
• Information/Knowledge Sharing
• Judgment
• Listening
• Planning/Priority Setting
• Problem Solving
• Team Player
• Time Management
• Written/Oral Communication & Organizational Skills

Benefits

Comprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition Reimbursement

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission-driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!