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CategoryHealthcare
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No of Jobs1
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Apply Before09/18/2025
Description
Case Manager RN - Oncology or Specialty Pharmacy
The Muse - Montgomery, AL
Job Title: Case Manager RN - Oncology or Specialty Pharmacy
Position: Medical Management for Aetna/CVS Health
Job Type: Full Time
Pay: $54,095.00 - $155,538.00
Shift: 8:30am-5:00pm
Work Type: Remote
Location
Address:
City: Montgomery
State: AL
ZIP Code:
Job Responsibilities
- 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.
- Assess benefits and/or member's needs to ensure appropriate administration of benefits.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and address complex health and social indicators impacting care planning and resolution of member issues.
- Utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Consult with supervisor and others to overcome barriers in meeting goals and objectives.
- Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilize a holistic approach to consult with clinical colleagues, supervisors, Medical Directors and/or other programs.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Utilize motivational interviewing skills to ensure maximum member engagement.
- Identify and escalate member's needs appropriately following set guidelines and protocols.
- Actively reach out to members to collaborate/guide their care.
- Perform medical necessity reviews.
Required Skills
Core Skills
- Registered Nurse with active, unrestricted state license
- Experience with electronic documentation
- Clinical judgment
- Motivational interviewing
Preferred Skills
- Case management experience
- Experience in Utilization Review
- CCM or other URAC recognized accreditation
- Experience with MCG, NCCN and/or Lexicomp
- Bilingual in Spanish
Requirements
Experience: 5+ years as a Registered Nurse, including at least 1 year in a hospital setting
Education: Diploma or Associates Degree in Nursing required; BSN preferred.
License & Certification:
- Active, unrestricted Registered Nurse license
- Willingness to receive multi-state/compact privileges
Schedule:
- Not specified
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost wellness programs
- Paid time off
- Flexible work schedules
- Family leave
- Tuition assistance
- Colleague assistance programs
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Facility Details
Name: The Muse
Description: A medical management company that is a division within Aetna/CVS Health, providing flexible medical management services.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: Building a world of health around every consumer.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
09/18/2025
Posted:
06/18/2025
