Care Manager - Registered Nurse

CVS Health • Washington, NV

1d • $60,522 - $129,615 • Remote

About The Position

The Nurse Care Manager assesses, plans, implements, and coordinates case management activities with members, by telephone and/or face to face, to evaluate medical needs and support overall wellness. The role develops proactive actions to improve short- and long-term outcomes and integrates strategies, policies, and programs related to network management and clinical coverage.

Using clinical tools and information and data review, the Care Manager evaluates member needs and benefit-plan eligibility, facilitates integrative functions, and supports transitions to Aetna programs and plans. The role applies clinical judgment to reduce risks and barriers and address complex health and social factors affecting care planning. Assessments consider information from multiple sources, including co-morbidities, multiple diagnoses, functionality, work capacity, restrictions, and limitations. The Care Manager reviews prior claims and uses a holistic approach to determine whether referrals to clinical resources are needed.

The role consults with supervisors and others to overcome barriers, presents cases at multidisciplinary case conferences, 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 position open to candidates residing in any U.S. state. Work is normally Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s time zone, with an occasional late-shift rotation from 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, and unrestricted Registered Nurse license in the state of residence.
• Willingness and ability to obtain additional state licenses after 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-shift rotations from 10:30 a.m. to 7:00 p.m. Eastern Time.
• Strong computer skills.
• Familiarity with Microsoft Suite.
• Associate degree with RN licensure.

Nice To Haves

• Compact State licensure.
• CCM certification.
• Experience in care case management.
• Home Care experience.
• Spanish speaking/bilingual.
• Oncology experience/background.
• BSN.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members by telephone and/or face to face.
• Evaluate members’ medical needs and develop proactive actions to improve short- and long-term outcomes and overall wellness.
• Use clinical tools and information and data review to evaluate member needs and benefit-plan eligibility and facilitate transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risks and barriers and address complex health and social factors affecting care planning and resolution of member issues.
• Assess conditions, co-morbidities, diagnoses, functionality, work capacity, and related restrictions or limitations using information from multiple sources.
• Review prior claims for potential impacts on current case management and eligibility.
• Use a holistic approach to assess the need for referrals to clinical resources to help determine functionality.
• Consult with supervisors and others to overcome barriers to goals and objectives.
• Present cases at multidisciplinary case conferences to support overall claim management.
• Follow case management processes in compliance with regulatory and company policies and procedures.
• Use motivational interviewing skills to encourage member engagement and discern health status.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.
• Eligibility 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