Case Management Nurse – Oncology, Transplant Experience

🕒 6 days ago

🌵 Arizona, Idaho, +1 more states – Remote

🌵 Arizona – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Innovative Care Management, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1990

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Innovative Care Management, Inc. is a healthcare services company that partners with TPAs, brokers, unions, health plans and stop-loss providers to provide utilization management and care management services focused on improving outcomes and controlling costs. Their offerings include preauthorization, care coordination, maternity (Healthy Mother Baby) programs, member advocacy and engagement, chronic condition management, controlled substance monitoring, and chiropractic utilization management. They emphasize a member-first, compassionate approach, privacy, diversity, equity and inclusion, and work to help members understand options and reduce out-of-pocket costs.

📋 Description

• Identify members who would benefit from case management using claims data, referrals, and clinical records • Review referrals for clinical appropriateness using sound judgment and program parameters • Conduct comprehensive assessments of medical, behavioral, and social needs using a whole-person approach • Develop individualized care plans based on patient needs, barriers, and goals • Coordinate care across the continuum, including primary care, oncology providers, transplant teams, specialists, behavioral health, and community-based resources • Facilitate clear communication between patients, providers, caregivers, and health plans to support safe transitions of care and adherence to treatment plans • Provide telephonic case management for high-utilization patients with complex or chronic conditions • Use best practices in chronic disease management, motivational interviewing, and patient education • Advocate for timely, appropriate, and cost-effective care while balancing clinical judgment with plan guidelines • Support patients in navigating healthcare systems and overcoming barriers to care • Evaluate precertification requests using evidence-based criteria and plan-specific guidelines • Review ongoing inpatient stays and make length-of-stay determinations as appropriate • Document all assessments, interventions, communications, and determinations thoroughly and accurately in ICM systems

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in good standing • Associate’s or Bachelor’s degree in Nursing • 5+ years of clinical nursing experience • Current or recent oncology nursing experience • Current or recent transplant nursing experience (solid organ, living donor, HSCT/BMT, or tissue transplant) • Strong knowledge of chronic disease management, utilization management, and social determinants of health • Experience managing complex, high-utilization patient populations • Excellent written and verbal communication skills with empathy, professionalism, and emotional intelligence • Strong organizational skills with the ability to manage multiple priorities independently • Sound clinical judgment and confidence navigating complex or sensitive situations • Comfort working independently in a remote environment with strong accountability and follow-through • Ability to manage confidential information in compliance with HIPAA • Must reside in Iowa, Arizona, or Idaho • Ability to work four 10-hour shifts per week and support coverage during ICM’s standard operating hours of 8:00 AM–5:00 PM Pacific Time

🏖️ Benefits

• Flexible work arrangements • Professional development