Care Manager - Registered Nurse

CVS Health • New Albany, IN

2d • Remote

About The Position

The Nurse Care Manager is responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating case management activities with members. The role evaluates medical needs to support overall wellness and develops proactive plans to address issues, improve short- and long-term outcomes, and identify opportunities to enhance wellness through integrated services.

Using clinical tools and information and data review, the Care Manager evaluates member needs and benefit-plan eligibility, facilitates integrated functions, and supports smooth transitions to Aetna programs and plans. The position applies clinical judgment to strategies that reduce risk factors and barriers and address complex health and social indicators affecting care planning and issue resolution. Assessments consider information from multiple sources, including co-morbidities, multiple diagnoses, functionality, work capacity, and related restrictions or limitations. The Care Manager reviews prior claims, considers referrals to clinical resources to help determine functionality, consults with supervisors and others to overcome barriers, and presents cases at multidisciplinary conferences. The role follows regulatory and company policies and procedures and uses motivational interviewing skills to support member engagement and understand health status.

This is a 100% remote role open to candidates residing in any U.S. state. Positions are available across time zones, with a preference for Pacific Standard Time. Regular hours are Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s time zone, with an occasional late-shift rotation of 10:30 a.m. to 7:00 p.m. Eastern Time, approximately one to two times per quarter. Typical training hours are Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time.

Requirements

• Active, current, unrestricted Registered Nurse license in the state of residence.
• Willingness and ability to obtain additional state licenses upon hire; the company pays for them.
• At least 5 years of acute care experience as a Registered Nurse.
• Willingness and ability to work Monday through Friday, 8:00 a.m. to 4:30 p.m. in the time zone of residence, with occasional late shifts from 10:30 a.m. to 7:00 p.m. Eastern Time.
• Strong computer skills.
• Familiarity with Microsoft Suite.
• Associate degree with RN licensure required.

Nice To Haves

• Compact State licensure.
• CCM certification.
• Experience in care case management.
• Home Care experience.
• Spanish speaking/bilingual ability.
• Oncology experience or background.
• Bachelor of Science in Nursing (BSN).

Responsibilities

• Assess members telephonically and/or face to face to evaluate medical needs and overall wellness.
• Plan, implement, and coordinate case management activities with members.
• Develop proactive courses of action to address issues and improve short- and long-term outcomes.
• Use clinical tools and data to evaluate member needs and benefit-plan eligibility and facilitate integration and transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators affecting care planning and issue resolution.
• Consider co-morbidities, multiple diagnoses, functionality, work capacity, and related restrictions or limitations in assessments.
• Review prior claims for potential impact on current case management and eligibility.
• Assess whether referrals to clinical resources are needed to help determine functionality.
• Consult with supervisors and others to overcome barriers to goals and objectives.
• Present cases at case conferences to support multidisciplinary claim management.
• Follow regulatory requirements and company policies and procedures for case management.
• Use motivational interviewing skills to promote member engagement and discern health status.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting colleagues’ physical, emotional, and financial well-being, based on eligibility.
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree