Complex Case Manager RN - Oncology (Remote)

Lensa; Columbus (OH); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking a Complex Case Manager RN specializing in Oncology to oversee a panel of members with diverse health needs. This role involves developing care plans, coordinating resources, and collaborating with a multidisciplinary team to enhance patient outcomes. Candidates should have significant clinical experience and strong communication skills, with a focus on improving health management and quality outcomes.

Qualifications

• 7 years of clinical, case management, or related experience required.
• RN license in PA, WV, DE, or NY required; others within 6 months.
• Oncology experience and Certification in Case Management preferred.

Responsibilities

• Oversee a panel of members and assess their needs.
• Create and manage care plans to improve health outcomes.
• Achieve targeted patient goals and document compliance.

Skills

Strong communication

Negotiation

Influencing skills

Knowledge of disease processes

Healthcare costs

Data analysis

Interpersonal skills

Organizational skills

Time management

Self-directed

Education

High School Diploma/GED

Bachelor's Degree in Nursing

Tools

MS Excel

Job description

Complex Case Manager RN - Oncology (Remote)

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Company: Highmark Inc.

Job Description

This role involves primary ownership and oversight of a designated panel of members with varying health statuses and clinical needs. The incumbent assesses health management needs, uses data analytics and clinical judgment to identify appropriate interventions, and collaborates with a multidisciplinary team to refer members to resources. Responsibilities include developing care plans, encouraging behavior change, addressing barriers, coordinating care, and monitoring quality outcomes.

Essential Responsibilities

• Oversee a panel of members, assess needs, and triage to resources.
• Create and manage care plans to improve health outcomes.
• Achieve targeted patient goals and document activities in compliance with regulations.
• Maintain knowledge of CMS, state, local, and accreditation standards.
• Perform other duties as assigned.

Education

• Required: High School Diploma/GED

Preferred: Bachelor's Degree in Nursing

Experience

• Required: 7 years of clinical, case management, or related experience.
• Preferred: Experience with cognitive behavioral therapy, motivational interviewing, or dialectical behavior therapy; working with diverse populations; understanding of cultural competency.

Licenses and Certifications

• Required: RN license in PA, WV, DE, or NY; others within 6 months.
• Preferred: Oncology experience; Certification in Case Management.

Skills

• Strong communication, negotiation, and influencing skills.
• Broad knowledge of disease processes and healthcare costs.
• Proficiency in MS Excel and data analysis.
• Excellent interpersonal, organizational, and time management skills.
• Self-directed with ability to work independently.

Additional Information

Position is office-based with occasional travel, physical demands are minimal, and compliance with privacy and ethical standards is required.