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- Downers Grove, IL
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Oncology Case Manager / Utilization Manager RN - Downers Grove, IL or Telecommute Potential
UnitedHealth Group • Downers Grove, IL
Posted 6 days ago
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This position will be located onsite in our Downers Grove, IL location OR can be telecommute / work from home from anywhere in US. There will be potential travel up to 10% of the time to Downers Grove, IL or Minnesota for quarterly meetings or as needed.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Support the Oncology Medical Director in the creation, implementation and refinement of an Oncology utilization management program
- Serve as a subject matter expert in evidence-based oncology guidelines – especially those produced by the National Comprehensive Cancer Network (NCCN) – and help interpret them to write clinical guidelines, job aides, and decision trees. These items will help ensure the program’s policies and processes are informed by the best available evidence
- Perform utilization review determinations for oncology populations (includes evaluating appropriateness and efficiency of requested health care services, procedures, and cancer treatments under the provisions of the applicable health benefits plan)
- Engage with providers via outbound calls to assess patient's current health status and coordinate care
- Identify gaps or barriers in patient treatment plans (based on evidence-based guidelines)
- Collaborate with Medical Directors on challenging cases
- Document and track findings
- Active, unrestricted RN license in the state of residence
- Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required
- 3+ years of Oncology experience in a Hospital setting, Acute Care, Direct Care experience or experience as an Oncology Telephonic Case Manager for an insurance company
- Experience working with NCCN (National Comprehensive Cancer Network) guidelines
- Chemotherapy administration experience
- Access to high speed internet and dedicated work space from home
- OCN or other oncology related certifications
Experience in medical care delivery systems, utilization management, case management, disease management, quality management, and/or product development
- A background in managed care
- Certified Case Manager (CCM)
- Bilingual (Spanish/English) skills
- Computer proficiency, to include strong data entry skills and the ability to navigate a Windows environment
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Oncology, Cancer, Case Manager, Care Coordinator, Utilization Management, Utilization Review, RN, Nurse, Chemotherapy, National Comprehensive Cancer Network, NCCN, OCN, CCM, Downer's Grove, IL, Illinois, telecommute