Complex Case Manager RN (Oncology)

TL;DR

Complex Case Manager RN (Oncology): Managing a panel of oncology patients by assessing health needs, developing comprehensive care plans, and coordinating multi-disciplinary clinical interventions with an accent on improving clinical, financial, and functional outcomes. Focus on navigating complex care barriers, influencing patient behavior changes, and ensuring compliance with regulatory standards and evidence-based practice.

Location: Must be based in Pennsylvania or hold a valid multi-state RN license (eNLC, WV, DE, or NY)

Company

A leading health insurance and care delivery organization dedicated to improving health outcomes through innovative clinical management and patient-centered support.

What you will do

• Maintain oversight of a specified member panel, assessing health management needs and identifying appropriate clinical interventions.
• Develop and manage individualized care plans with both short and long-term goals to address patient needs and remove care barriers.
• Conduct regular outreach to members to encourage behavior changes and coordinate necessary resources.
• Monitor and improve quality outcomes, ensuring clinical, financial, and functional goals are met.
• Document all activities in strict compliance with regulatory requirements, accreditation standards, and HIPAA guidelines.
• Collaborate with multi-disciplinary teams to triage members and ensure access to appropriate support resources.

Requirements

• Current State of PA RN licensure or multi-state licensure through the enhanced Nurse Licensure Compact (eNLC), WV, DE, or NY.
• 7 years of experience in clinical, case management, disease management, or health insurance operations.
• Bachelor's Degree in Nursing.
• Strong proficiency in MS Excel and ability to interpret clinical and financial data.
• Excellent interpersonal, negotiation, and influencing skills.
• Ability to work with moderate autonomy in a fast-paced, high-performing environment.

Nice to have

• Certification in Case Management (CCM).
• Advanced training in cognitive behavioral therapy (CBT), motivational interviewing, or dialectical behavior therapy (DBT).
• Experience working with diverse populations and understanding of cultural competency.

Culture & Benefits

• Opportunity to work in a high-performing, multi-disciplinary team environment.
• Focus on professional growth and adherence to evidence-based clinical standards.
• Commitment to ethical business conduct and data security.
• Supportive environment for clinical professionals managing complex patient panels.