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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 - Montgomery, AL
Job Title: Case Manager RN - Pediatrics, Oncology or Specialty Pharmacy
Position: Telephonic Case Management role
Job Type: Full Time
Pay: $54,095.00 - $155,538.00, eligible for bonuses and incentives
Shift: 8:30am-5:00pm within time zone of residence
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.
- Apply and interpret 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 barriers and address complex health and social indicators that impact care planning.
- Conduct assessments utilizing information from various sources to address all conditions, including co-morbidities 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 case management processes in compliance with regulatory and company policies and procedures.
- Employ motivational interviewing skills to ensure maximum member engagement and assess their health status/needs.
- Identify and escalate member's needs appropriately following guidelines.
- Actively reach out to members to collaborate and guide their care.
- Perform medical necessity reviews.
Required Skills
Core Skills
- Registered Nurse with active, unrestricted license in state of residence
- Case management skills
- Electronic documentation skills
- Assessment and consultation skills
Preferred Skills
- Case Management experience
- Experience with MCG, NCCN and/or Lexicomp
- Bilingual in Spanish
Requirements
Experience: 5+ years as a Registered Nurse with at least 1 year in a hospital setting
Education: Diploma or Associates Degree in Nursing required; BSN preferred
License & Certification:
- Active 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 including matching company contributions
- Employee stock purchase plan
- No-cost wellness screenings and tobacco cessation programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for bonuses, commissions, or short-term incentive programs
Special Notes
- Committed to fostering a diverse workplace where everyone feels valued and belongs.
Facility Details
Name: The Muse
Description: Leading health solutions company, caring for people in a compassionate way.
Specialties:
- Medical Management
- 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
