Case Manage Registered Nurse - Field - Must reside near Richmond

CVS Health•Richmond, VA

4d•Hybrid

About The Position

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. This position is for Virginia Only candidates with up to 70% travel required in Central region. The Nurse Case Manager is responsible for assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach, assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Requirements

RN/BH with current unrestricted Virginia state licensure required.
3 years clinical experience
Must reside in Richmond, Virginia or Surrounding Areas
Must possess reliable transportation and be willing and able to travel up to 75% of the time.
Mileage is reimbursed per our company expense reimbursement policy
Driver's License

Nice To Haves

Case Management in an integrated model preferred
5 years clinical practice experience
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written.
Bilingual in English/Spanish

Responsibilities

Assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
Developing a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
Conducting an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applying clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Reviewing prior claims to address potential impact on current case management and eligibility.
Assessing the member’s level of work capacity and related restrictions/limitations.
Assessing the need for a referral to clinical resources for assistance in determining functionality.
Consulting with supervisor and others in overcoming barriers in meeting goals and objectives.
Presenting cases at case conferences for multidisciplinary focus to benefit overall claim management.
Utilizing case management processes in compliance with regulatory and company policies and procedures.
Utilizing interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.