Case Manager, Registered Nurse – Oncology Experience Required

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🔥 1 hour ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $54.1k - $155.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Work intensely as a telephonic case manager with patients and their care teams for fully and/or self-insured clients • Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards • Assess benefits and member needs to ensure appropriate administration of benefits • Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators impacting care planning • Assess co-morbid and multiple diagnoses affecting functionality using information from various sources • Consult with supervisors, clinical colleagues, Medical Directors, and other programs to overcome barriers • Present cases at case conferences for multidisciplinary focus and overall claim management • Use case management processes in compliance with regulatory and company policies and procedures • Use motivational interviewing to maximize member engagement and assess health status and needs • Identify and escalate member needs according to guidelines and protocols • Actively reach out to members to collaborate on and guide their care • Perform medical necessity reviews

🎯 Requirements

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting • Active multistate RN license through the Nurse Licensure Compact (NLC) for nurses residing in compact states, or individual state-specific RN licenses for each supported state for nurses residing in non-compact states • 1+ years’ experience documenting electronically using a keyboard • 1+ years’ current or previous experience in Oncology • Diploma or Associates Degree in Nursing required • 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience preferred • Experience transferring patients to lower levels of care preferred • 1+ years' experience in Utilization Review preferred • CCM and/or other URAC recognized accreditation preferred • 1+ years’ experience with MCG, NCCN and/or Lexicomp preferred • Bilingual in Spanish preferred • BSN preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Virtual training

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