Case Manager RN - Pediatrics, Oncology or Specialty Pharmacy

The Muse - Phoenix, AZ

Job Title: Case Manager RN - Pediatrics, Oncology or Specialty Pharmacy

Position: Telephonic Case Manager for American Health Holding, Inc.

Job Type: Full Time

Pay: $54,095.00 - $155,538.00

Shift: 8:30 AM - 5:00 PM

Work Type: Remote

Location

Address:

City: Phoenix

State: AZ

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 and procedures, and regulatory standards while assessing benefits and/or member's needs.
Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning.
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 to benefit overall claim management.
Use a holistic approach to consult with clinical colleagues, supervisors, Medical Directors, and other programs.
Utilize case management processes in compliance with regulatory and company policies and procedures.
Use motivational interviewing skills to ensure maximum member engagement.
Actively reach out to members to collaborate and guide their care.
Perform medical necessity reviews.

Required Skills

Core Skills

Clinical judgment
Motivational interviewing
Case management processes
Documentation using electronic systems

Preferred Skills

Case Management experience
Discharge planning experience
Nurse navigator or nurse care coordinator experience
Experience with Utilization Review
Bilingual in Spanish

Requirements

Experience: 5+ years as a Registered Nurse with at least 1 year in a hospital setting and 1+ years in Pediatrics, Oncology, or Specialty Pharmacy.

Education: Diploma or Associates Degree in Nursing required; BSN preferred.

License & Certification:

Active, unrestricted RN license in state of residence
Willingness to receive multi-state/compact privileges

Schedule:

Full time, 40 hours per week

COVID-19 Requirements: Not Specified

Benefits

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost programs for wellness screenings, tobacco cessation, weight management 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 CVS Health bonus, commission, or short-term incentive program

Special Notes

Organizational commitment to fostering a workplace where every colleague feels valued and belongs.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.