RN Care Manager – Oncology

🕒 Agosto 11

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

💵 $28 - $53 / hora

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Capital Blue Cross

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1938

🏥 Saúde

💼 Consultoria

🛡️ Seguros

Healthcare • Consulting • Insurance

A Capital Blue Cross é uma companhia de seguros de saúde que oferece uma gama de planos de saúde para indivíduos, famílias e empregadores. Eles atendem clientes na região central da Pensilvânia e no Vale de Lehigh, com foco em fornecer serviços de cobertura de saúde, como planos Medicare, planos de saúde estudantil e recursos para gerenciar cuidados médicos. A Capital Blue Cross se posiciona como uma parceira na saúde, enfatizando o apoio ao bem-estar geral dos membros e medidas de saúde preventiva.

Descrição

• Coordinate services for members meeting established criteria, emphasizing education, self-management, quality care, and cost-effective outcomes • Assess member needs, review service and resource options, develop and implement plans of care, coordinate resources, monitor progress, evaluate status, and discharge members • Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs • Provide counseling and referrals to community, local, state, and other programs • Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources • Manage and oversee a caseload of moderate- to high-risk members with complex medical, behavioral, and psychosocial needs • Serve as liaison among participants, families, physicians, and treatment team members • Develop prioritized goals and health actions supporting self-directed care and improved health outcomes • Advocate for members and families by coordinating care and navigating resources • Analyze referrals for potential enrollment and conduct participant-centered assessments • Obtain required consent forms and apply discharge criteria • Document care management activities according to policies and procedures • Build relationships and implement interventions supporting knowledge, self-management, and stabilization • Identify and report quality-of-care issues • Maintain member confidentiality • Attend company and departmental meetings and training sessions

🎯 Requisitos

• Registered Nurse with active licensure in home state • Additional state licensure as needed or required to meet customer needs • Certified Case Management certification within 2 years of employment • At least three years of recent, related experience • Minimum of three years of clinical experience in social work counseling with complex psychiatric and substance abuse or substance use disorder treatment, or equivalent combination of education and experience • Care management, home health, medical/surgical behavioral health, and/or critical care experience preferred • Health plan experience preferred • Oncology experience preferred • Health coaching and motivational interviewing experience preferred • Knowledge of NCQA, DMAA, CMSA, Act 68, CMS, and ERISA standards • Knowledge of evidence-based guidelines for chronic conditions and care management • Knowledge of clinical and managed care principles and operations • Knowledge of medical treatment modalities and best-practice guidelines • Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques • Strong communication, clinical process, critical thinking, problem-solving, written, oral, listening, and organizational skills • Ability to use a computer system while conversing by telephone • Strong customer service skills, tact, and diplomacy • Ability to prioritize workload and complete duties accurately and timely • Ability to work autonomously and as part of an interdisciplinary team • Sound judgment regarding members’ and healthcare stakeholders’ rights and responsibilities • Proficiency in Microsoft Office products • Ability to travel to provider, facility, employer group, and/or member locations using own vehicle, if appropriate

🏖️ Benefícios

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible work environment • Training and continuing education • Opportunities to volunteer in the community