Case Manager, Registered Nurse – Oncology Experience Required

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🔥 2 hours ago

⚜️ Louisiana, Montana, +3 more states – Remote

⚜️ Louisiana – Remote 🦬 Montana – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🤠 Texas – Remote

💵 $54.1k - $155.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member’s needs • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers • Consults with supervisor and others in overcoming barriers in meeting goals and objectives • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs • Utilizes case management processes in compliance with regulatory and company policies and procedures • Utilizes motivational interviewing skills to ensure maximum member engagement • Identifies and escalates member’s needs appropriately following set guidelines and protocols • Actively reach out to members to collaborate/guide their care • Perform medical necessity reviews

🎯 Requirements

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting • 1+ years’ experience documenting electronically using a keyboard • 1+ years’ current or previous experience in Oncology • Preferred: 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience • Preferred: 1+ years' experience in Utilization Review • Preferred: 1+ years’ experience with MCG, NCCN and/or Lexicomp • Bilingual in Spanish preferred • Education: Bachelors Degree Education Diploma or Associates Degree in Nursing required

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility