RN Care Manager – Oncology

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $28 - $53 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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