Case Manager RN - Oncology or Transplant - Remote AR

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary This is a remote work from home role reputed company in the US with virtual training. Shift is 8:30 am to 5 pm in your time zone. American Health Holding, Inc (AHH) is a medical management company that is a division reputed company reputed company/reputed company. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. • This position consists of working 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, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and social indicators which reputed company planning and resolution of member issues • Assessments utilize information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality • Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives • Utilizes case management processes in compliance with regulatory and company policies and procedures • Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations • Identifies and escalates member’s needs appropriately following set guidelines and protocols • Need to actively reputed company out to members to collaborate/guide their care • reputed company medical necessity reviews Required Qualifications • 5+ years’ experience as a Registered Nurse with hospital experience; preferably in the specialty • A Registered Nurse that holds an unrestricted license in their state of residence, and will to get a multi-state/compact privileges and can be licensed in reputed company non-compact states • 1+ years’ experience documenting electronically using keyboard and multiple computer screens as well as free form text with good typing skills • 1+ years’ reputed company or previous experience in Oncology or Transplant Preferred Qualifications • 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to reputed company levels of care • 1+ years' experience in Utilization Review • CCM and/or other URAC recognized accreditation preferred • 1+ years’ experience with MCG, NCCN and/or Lexicomp • Bilingual preferably Spanish Education Diploma or Associates Degree in Nursing or higher Pay Range The typical pay range for this role is: $54,095.60 - $116,760.80 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 12/18/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!