Registered Nurse, Case Manager - Oncology or Specialty Pharmacy Advocacy

The Muse; Annapolis (MD); Remote; USD 54,000 - 156,000; Full time

Job summary

The Muse is seeking a Registered Nurse, Case Manager specializing in Oncology or Specialty Pharmacy Advocacy. This remote position involves providing telephonic case management, utilizing clinical guidelines, and engaging with patients to improve their care. Ideal candidates will possess extensive experience in nursing with an active RN license and a strong ability to manage complex health situations.

Benefits

Medical plans

401(k)

Employee stock purchase

Wellness programs

Paid time off

Flexible schedules

Family leave

Tuition assistance

Qualifications

• 5+ years' experience as a Registered Nurse with at least 1 year in a hospital setting.
• Active RN license with willingness for multi-state/compact privileges.
• 1+ years' experience in Oncology or Specialty Pharmacy.

Responsibilities

• Apply clinical guidelines and care management plans for patient assessments.
• Develop strategies to reduce health risk factors and address complex conditions.
• Engage members through motivational interviewing to assess health needs.

Skills

Clinical judgment

Motivational interviewing

Care management planning

Education

Diploma or Associate Degree in Nursing

BSN

Tools

Electronic documentation systems

Job description

Registered Nurse, Case Manager - Oncology or Specialty Pharmacy Advocacy

Join to apply for the Registered Nurse, Case Manager - Oncology or Specialty Pharmacy Advocacy role at The Muse.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. We do it all with heart, each and every day.

Position Summary

This is a remote work-from-home role anywhere in the US with virtual training. The shift schedule is 8:30 am - 5 pm within the time zone of residence.

American Health Holding, Inc (AHH) is a division within Aetna/CVS Health, founded in 1993, URAC accredited in Case Management, Disease Management, and Utilization Management. AHH provides flexible medical management services supporting cost-effective, quality care for members.

The role involves working as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

• Apply clinical guidelines, care management plans, policies, procedures, and regulatory standards to assess benefits and member needs.
• Use clinical judgment to develop strategies to reduce risk factors and address complex health and social indicators impacting care planning.
• Perform assessments using information from various sources to address all conditions, including co-morbidities and multiple diagnoses.
• Consult with supervisors and colleagues, present cases at case conferences, and collaborate to overcome barriers in meeting goals.
• Utilize case management processes in compliance with regulations and company policies.
• Engage members using motivational interviewing to discern health status and needs.
• Identify and escalate member needs appropriately, actively reach out to members to guide their care, and perform medical necessity reviews.

Required Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• Active, unrestricted RN license in the state of residence, with willingness to obtain multi-state/compact privileges.
• 1+ years' experience in Oncology or Specialty Pharmacy.
• Experience documenting electronically using a keyboard.

Preferred Qualifications

• 1+ years' experience in Case Management, discharge planning, nurse navigation, or nurse care coordination.
• Experience with Utilization Review, URAC accreditation, and familiarity with MCG, NCCN, or Lexicomp.
• Bilingual in Spanish preferred.

Education

• Diploma or Associate Degree in Nursing required; BSN preferred.

Additional Details

• Full-time, 40 hours/week.
• Pay range: $54,095 - $155,538, depending on experience and location.
• Benefits include medical plans, 401(k), employee stock purchase, wellness programs, paid time off, flexible schedules, family leave, tuition assistance, and more.

Application deadline: 07/08/2025. Qualified applicants with arrest or conviction records will be considered in accordance with laws.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Healthcare