Oncology Nurse Consultant - Registered Nurse

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Are you an experienced Oncology Nurse looking for an opportunity to make a meaningful impact throughout a patient's cancer journey? Join our innovative Oncology Care Model team and serve as a clinical leader, care coordinator, and utilization management expert, helping members navigate treatment, access appropriate care, and achieve the best possible outcomes.

The Oncology Nurse Consultant serves as a hybrid Care Management and Utilization Management professional, providing comprehensive support to oncology members from diagnosis through treatment and recovery.

As part of an interdisciplinary team that includes a Medical Director, Nurse Practitioner, Pharmacist, Behavioral Health Specialist, and Oncology Companion, you will work collaboratively to ensure members receive evidence-based, coordinated, and cost-effective oncology care.

• Conduct comprehensive clinical assessments and identify members who would benefit from oncology case management services
• Develop, implement, and monitor individualized care management plans
• Assess medical, psychosocial, functional, and support needs throughout the cancer journey
• Advocate for members to maximize available healthcare benefits and services
• Support transitions of care, discharge planning, and ongoing treatment coordination
• Identify and escalate quality-of-care concerns through established channels

• Serve as a trusted clinical resource for members and caregivers throughout treatment
• Coordinate care with oncologists, specialists, hospitals, providers, and community resources
• Evaluate members' health literacy, readiness for change, and support needs
• Provide education, coaching, and ongoing support to help members make informed healthcare decisions
• Utilize motivational interviewing techniques to improve engagement and treatment adherence

• Perform utilization reviews and evaluate medical necessity for oncology-related services
• Apply evidence-based oncology guidelines and clinical criteria to support treatment decisions
• Leverage NCCN guidelines to assess treatment plans and support adherence to best practices
• Partner with Medical Directors and treating providers to review treatment exceptions and clinical variances
• Review medical records and clinical documentation to ensure appropriate utilization of healthcare resources
• Support cost-effective treatment recommendations while maintaining quality patient outcomes

• Participate actively in multidisciplinary oncology team discussions
• Consult with providers, internal stakeholders, and healthcare partners regarding utilization management and care planning
• Contribute ideas and recommendations to improve program effectiveness and member experience
• Support organizational goals focused on quality, outcomes, and healthcare resource optimization

• Active, unrestricted RN license in state of residence
• Ability to obtain multi-state licensure upon hire
• Current Oncology Nursing Certification Corporation (ONCC) certification, including one of the following:
  • OCN
  • CPHON
  • CBCN
  • TCTCN
  • AOCNP
  • ROCNTM
  • AOCNS
  • AOCN
• 5+ years of oncology nursing experience
• 2+ years of Utilization Management experience
• Knowledge of:
  • Oncology treatment protocols
  • Cancer symptom management
  • Supportive care services
  • Evidence-based oncology guidelines
  • Medical necessity criteria
• Experience collaborating with multidisciplinary healthcare teams
• Excellent clinical judgment, critical thinking, and communication skills

• Compact RN license
• Certified Case Manager (CCM) certification
• Telephonic case management experience
• Telephonic customer service or care management experience
• Managed Care experience
• Experience working remotely and independently

• Associate Degree in Nursing required
• BSN preferred

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

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