RN, Care Manager
Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat. Job Description:
Cancer care is all we do
Hope in healing
Hours: Mon - Fri 8:00am - 4:30pm
Job Summary/Purpose: This position requires advanced knowledge in the field of nursing science and ability to make independent decision-making.
Care Manager is responsible for the coordination of all systems/services required for an organized, multidisciplinary team approach and assures quality, cost-efficient care for an oncology patient caseload.
Care Manager functions as advocate and contact person for patient, family, healthcare team members, employees and outside agencies to assure continuity of care and optimal clinical and resource outcomes. Participation in an on-call rotation will be required based on departmental need.
Utilization Review Nurse (UR RN) extracts and reviews relevant medical documentation (i.e., physician documentation, laboratory and diagnostic findings, medication, etc.) and uses nationally recognized acute care indicators and criteria (Milliman Guidelines) to make independent, accurate daily medical necessity, level of care, and length of stay determinations for all observation and inpatient case
Acts as a liaison between CCRC Chicago and outside agencies (Medicare/Medicaid, commercial, and managed care payers) by providing initial and concurrent clinical reviews (both written and verbal) in order to secure insurance authorization and appropriate reimbursement
Refers all cases that do not meet medical necessity guidelines to the Physician Advisor for review
Makes peer to peer review arrangements for denied cases
Serves as a resource and educator to the members of the care team (attending MDs, consultants, PAs, care managers, nursing, social workers, etc.) on utilization review and clinical documentation principles.
Works closely with other teams such as Pre-certification, Insurance Verification, Compliance, Coding, and Clinical Documentation.
Advanced knowledge in the field of nursing science
RN Licensure for the state of Illinois is required. Bachelor’s degree preferred
Knowledge of medical necessity/level of care criteria and local and national coverage determinations
2-5 years clinical experience; 1-3 years Utilization Review experience in the hospital or insurance industry preferred.
1-year experience in Care Management and/or similar role
Recent experience and working knowledge of the acute hospital discharge planning process
Knowledge of ICD and CPT coding preferred
Knowledge of statistics, data collection, analysis, and data presentation
Knowledge of clinical practice guidelines and the appropriateness of clinical interventions
Self-motivated, strong problem-solving skills
Proficiency with computer-based applications such as Microsoft products (Word, Excel, Outlook), review software (Milliman or Interqual), and Electronic Medical Record (EMR) is required
Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. Visit: Jobs.cancercenter.com to begin your journey.
We win together
Visit: Jobs.cancercenter.com to begin your journey.