Imagine360 is currently seeking a Case Manager, Hematology RN to join our team. This RN provides excellence in care through empowering patients, maintaining open communication, coordinating sequence of care, aiding in avoidance of complications, arranging alternative facilities, coordinating appropriate treatment with cost containment strategies, educating and supporting not only the m ember but the support systems. The Hematology Oncology RN Case Manager facilitates coordination of both inpatient and outpatient patients with active hematology-oncology diagnoses or in the family of diagnoses. Experience preferred in management of patients who are preparing to undergo or have previously had CAR-T, gene therapy, Bone Marrow/Stem Cell Transplant.
Position Location: 100% Remote
Responsibilities include but are not limited to:
- Identify, collect, process and manage data to perform the Case Management process by utilization of approved clinical guidelines and following Medical Management Policy and Procedures.
- Completes clinical assessments per P&P to identify and deliver indicated medical service coordination.
- Completes medical necessity, utilization management reviews, and review of benefits as part of the pre-determination process by utilizing GPA approved clinical guidelines.
- Identify and refer cases for Physician Advisor reviews.
- Utilize clinical knowledge, expertise and approved educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment.
- Assess the need for and collaborate with community resources for members in case management.
- Perform negotiations with providers.
- Uses assigned software accurately to document to complete and document all steps of review of medical necessity and case management process.
- Facilitate the Patient Satisfaction Surveys.
- Assess and document cost savings.
- Refer complex cases to Manager, Case Management as needed.
- Attend scheduled and periodic meetings, training and other job specific events as required either by teleconference or onsite
- Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and Medical Management Policy and Procedure.
- Participate in the Quality Management Program via collecting and adhering to performance metrics per Case Management Policy.
Areas of Responsibility Scope of Practice:
- In addition to performing standard duties, the Registered Nurse is involved in clinical decision-making and patient education. The scope of practice includes, but is not limited to:
- Evaluating clinical data
- Assessment and evaluation of the acquired clinical date to assess for appropriateness of treatment based on Imagine360 clinical guidelines,
- Coordination of treatment plans, interventions, and outcome measurement
- Rationale for the effects of medication and treatments
- Provide patient education and educational resources.
- Accurately report:
- Administration of medication and treatments
- Client response
- Contact with other health care team members.
- Respect the client’s right to privacy by protecting confidential information.
- Promote and participate in education and counseling to a participant based on health needs.
- Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.
- The Transplant Case Manager will have knowledge and practice the core components of Case Management that include:
- Case Management Concepts
- Principles of Practice
- HealthCare ManagementDelivery
- Healthcare Reimbursement
- Psychosocial Aspects of Care
- Rehabilitation
- Professional DevelopmentAdvancement
- Quality and Outcomes Evaluation and Measurement
- Ethical, Legal and Practice Standards
Required Experience / Education:
- Graduate of Accredited School of Nursing, college or university
- Minimum of one year experience in Utilization Management, Case Management, or transferable skills.
- Minimum of three years Hematology experience preferred
- Intermediate knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.
Licenses or Certifications:
- Current, active, and unrestricted compact Registered Nurse license. Must maintain CEU’s as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
- Current Certified Case Manager (CCM) Certificate preferred; if Certification is not current, employee must pursue and achieve CCM Certification within three years of employment.
What can Imagine360 offer you?
- Multiple Health Plan Options
- Company paid employee premiums for disability and life insurance
- Parental Leave Policy
- 20 days PTO to start / 10 Paid Holidays
- Tuition reimbursement
- 401k Company contribution
- Professional development initiatives / continuous learning opportunities
- Opportunities to participate in and support the company’s diversity and inclusion initiatives
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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we’ve helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today’s one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV’s submitted without permission or directly to Hiring Managers will be considered unsolicited, and no fee will be payable. Thank you for your cooperation**