Case Manager - Phoenix, AZ (Remote Position)

University Hospitals - Hudson, OH4.0

Full-timeEstimated: $51,000 - $73,000 a year
EducationSkills
Description
The Nurse Case Manager provides cancer related patient advocacy, case management and benefit navigation services for patients of designated employer groups and specific facilities. The registered nurse in this role is the primary care coordinator for the patient from the point of referral to the Centers of Excellence program and transitions to a secondary support role prior to the completion of the one year post evaluation visit for all related services as defined by the program scope.

Key Responsibilities
  • Achieve high quality, cost-effective outcomes compliant with Plan benefits and facility contracts for program participants
  • Utilize clinical resources, advanced clinical judgment and critical thinking skills to:
o Implement care plans to coordinate and facilitate appropriate services
o Provide utilization management services which adhere to established guidelines, contract and regulations
  • Promote optimal patient functioning and patient empowered decision making by providing education to patient and their support network
Additional Duties (as applicable)
  • Apply case management concepts to complex issues and utilize problem-solving techniques to promote optimum patient outcomes
  • Process referrals from multiple sources and investigate each case to determine if appropriate for enrollment based on established benefit, workflow criteria and patient consent
  • Essential responsibilities include, but are not limited to:
o Assess patient care needs based on established criteria
o Establish and continually update goals: short (the acute or immediate health crisis of the patient) and long (sustaining health improvements or optimal health status) term goals
o Discuss, plan, monitor and evaluate alternatives for patient care with the attending physician, Medical Director, patient and their support network and/or facilities or other care environment
o Manage and monitor all aspects of the patient care needs related to their cancer services through the continuum of care
o Ensure quality patient care is provided in the most appropriate setting
o Identify community and governmental resources available to augment medical benefit Plan
o Consult with Medical Director for case specific and program/workflow review as necessary and appropriate
o Co-case manage patient with nurse case managers at vendor partners as directed per workflow and protocols
  • Document in a standardized format in the Care Management documentation system in a timely, accurate and thorough manner
  • Authorize service based on Plan design and/or clinical guidelines
  • Arrange for communication between the Medical Director and the attending physician as necessary
  • Participate in weekend and holiday on-call time on a rotating basis as directed by clinical management per department protocols
  • Function as an educational resource in area of expertise for care management team
  • Participate in program development and process improvement as needed
  • Remain educated in current principles, procedures, and knowledge domain based on nationally recognized standards of case management and cancer care
  • Participate in client, vendor, case management and departmental staff meetings and patient case rounds
  • Participate in approved resolution process for resolving disagreements within the organization regarding patient’s options and/or disagreements with providers regarding patient’s needs
  • Complete any other tasks or duties necessary for program function as directed by the department manager or director, or for assistance to other departments as needed
  • Ensure the confidentiality of personal health information
  • Maintain current professional licensure(s).
Qualifications
Job Requirements
  • Registered Nurse in good standing with an active state license and three (3) years clinical practice experience AND practice Case Management within the scope of licensure (based on the standards of the discipline)
  • Bachelor Degree preferred
  • Certification as a Case Manager preferred upon hire, required upon completion of 12 month from hire date
  • Certification through ONS preferred upon hire, required upon completion of 12 months from hire date
  • Previous managed care experience desirable
  • Excellent communication skills
  • Ability to work independently, organized and multi-task essential
  • Proficiency in basic computer skills and ability to learn and utilize program software
  • Willingness to work collaboratively as part of the care management team
  • Flexibility in work assignments