Remote Senior Oncology RN Case Manager & Care Navigator

Highmark Health; Hawaii; À distance; USD 114 000 - 140 000; Plein temps

Résumé du poste

Highmark Health seeks a Case Manager to provide comprehensive case management services to members, ensuring quality, cost-effective care and optimal health outcomes.

The role involves assessing needs, developing and implementing care plans, coordinating services, monitoring progress, and containing healthcare costs by detecting and resolving improper utilization of benefits. Strong clinical knowledge and collaboration with providers are essential.

Qualifications

• 5 years in clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
• Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT).
• Expertise in clinical assessment and care planning.
• Proficiency in using Microsoft suite of applications, case management software and electronic health records.

Responsabilités

• Manage a caseload of members with complex health needs, requiring advanced clinical knowledge.
• Conduct comprehensive assessments and develop complex care plans.
• Assess members’ health status, needs, and available resources.
• Develop individualized care plans in collaboration with members, physicians, and other healthcare providers.
• Implement and coordinate care plans, ensuring access to appropriate services and resources.
• Monitor member progress toward goals and adjust care plans as needed.
• Act as an advocate and liaison to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating options and services.
• Work collaboratively and communicate clearly and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
• Ensure all activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
• Provide guidance and mentorship to lower-level Case Managers.
• Serve as a resource for clinical expertise and problem-solving.

Connaissances

Clinical management

Case/utilization management

Disease condition management

Provider operations

Health insurance experience

Oncology

Transplant

Maternity

NICU

Pediatric

Formation

Bachelors in Nursing

Outils

Microsoft Office

Case management software

Electronic health records

Description du poste

Highmark Health seeks a Case Manager to provide comprehensive case management services to members, ensuring quality, cost-effective care and optimal health outcomes.

The role involves assessing needs, developing and implementing care plans, coordinating services, monitoring progress, and containing healthcare costs by detecting and resolving improper utilization of benefits. Strong clinical knowledge and collaboration with providers are essential.