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This position’s primary focus is the management of members with specialty (oncology) diagnoses. This position will be responsible for performing all functions of case management (cm) and is a primary source of contact for members, health care personnel and all other entities involved in managing specialty care. The primary nurse case administrator performs care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health needs; promotes quality and cost- effective outcomes; and serves as liaison to physicians and members. Provide education/local resource information and encourage member (self) education functioning in a clinical care advisory role, the primary nurse case administrator assesses members for case management, introduces members to our website tools, educates members regarding their specific condition, and facilitates the coordination of care for identified members.

JOB REQUIREMENTS:

• Registered Nurse (RN) Compact License with current, valid, unrestricted license in state of operations

• 4 years clinical practice experience of direct clinical care, to include 3 years of recent Specialty (oncology certification) clinical experience

• Knowledge of specialty diagnosis drugs, adjunct therapies and treatment protocols including side effects and complications

• Current certification in one of the following: ONS/ONCC/AOCN/CPON/AOCNP/CDE/CDCDS PC proficiency to include Word, Excel, Lotus Notes and database experience

• Clear and concise verbal and written communication skills

• Knowledge of UM/CM/DM activities and standardized criteria set

• Familiarity of ancillary services including HHC, SNF, Hospice, etc

• Verbal and written communication skills; analytical skills; sound clinical judgment

• *Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC.

• Knowledge of drugs and treatment protocols including side effects and complications

• Knowledge of diets relating to assist members

• Knowledge of Problem Solving, Healthy Coping and establishing SMART goals.

• Current Certified Specialists must maintain their certification

PREFERRED JOB REQUIREMENTS:

• Oncology Certification required

• Registered Nurse Compact License

• Experience in managing complex or catastrophic health cases

• Inpatient and Outpatient experience preferred.

• 1-year experience in Care Management in a health insurance/managed care setting

• Current CCM certification

• Knowledge of medical management policies and procedures

• 1-year education experience in Specialty area

This position is REMOTE / TELECOMMUTE

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.