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CategoryHealthcare
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No of Jobs1
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Apply Before09/18/2025
Description
Case Manager RN - Pediatrics, Oncology or Specialty Pharmacy
The Muse - Little Rock, AR
Job Title: Case Manager RN - Pediatrics, Oncology or Specialty Pharmacy
Position: Registered Nurse - Telephonic Case Management
Job Type: Full Time
Pay: $54,095.00 - $155,538.00
Shift: 8:30am-5:00pm
Work Type: Remote
Location
Address:
City: Little Rock
State: AR
ZIP Code:
Job Responsibilities
- Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
- Apply and interpret applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs.
- Ensure appropriate administration of benefits.
- Apply clinical judgment to strategies designed to reduce risk factors and barriers to care.
- Address complex health and social indicators which impact care planning and resolution of member issues.
- Utilize information from various sources to address all conditions including co-morbid and multiple diagnoses.
- Consult with supervisor and others in overcoming barriers in meeting goals and objectives; present cases at case conferences.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Use motivational interviewing skills to maximize member engagement and assess health status.
- 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
- Telephonic case management
- Clinical judgment
- Motivational interviewing
- Electronic documentation
Preferred Skills
- Case Management experience
- Utilization Review experience
- Experience with MCG, NCCN, and/or Lexicomp
- Bilingual in Spanish
Requirements
Experience: 5+ years' experience as a Registered Nurse; 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:
- 40 hours per week
- Shift schedule: 8:30am-5:00pm
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- No-cost programs including wellness screenings and confidential counseling
- Flexible work schedules and paid time off
- Tuition assistance and retiree medical access
Supplemental Pay
- Eligibility for additional CVS Health bonus, commission or short-term incentive program
Special Notes
- Commitment to diversity and providing equal opportunity for applicants with arrest or conviction records.
Facility Details
Name: The Muse
Description: A medical management company that is a division within Aetna/CVS Health, founded in 1993 and URAC accredited.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: To deliver flexible medical management services that support cost-effective quality care for members.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
09/18/2025
Posted:
06/18/2025
