Case Manager Licensed Practical Nurse - Field - Arlington, Alexandra and Fairfax, VA

CVS Health•Fairfax, VA

30d•$22 - $49

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThis position will be serving the Arlington, Alexandra and Fairfax, VA. Monday-Friday Standard Business Hours. Nurse Case Manager is responsible for telephonically and/or face to face 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 socialindicators 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.Requisition Job DescriptionA Brief OverviewCoordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.What you will doExecutes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.Handles reviews of prior claims to address potential impact on current case management and eligibility.Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.Ensures case management processes follow organization and regulatory requirements.Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.Coaches and trains junior colleagues in techniques, processes, and responsibilities.For this role you will need Minimum RequirementsBasic awareness of problem solving and decision making skills

Requirements

LPN with current unrestricted Virginia state licensure required
3+ years clinical experience as a LPN ( behavioral health, acute/subacute care)
Must reside in Northern Virginia, specifically Fairfax County or Surrounding Areas
Must be willing and able to travel up to 75% of the time to meet members in their home
Basic awareness of problem solving and decision making skills

Nice To Haves

Case Management in an integrated model preferred
Bilingual in English/Spanish preferred
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written.

Responsibilities

Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members.
Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration.
Instructs programs and procedures in compliance with network management and clinical coverage policies.
Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.
Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.
Handles reviews of prior claims to address potential impact on current case management and eligibility.
Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.
Ensures case management processes follow organization and regulatory requirements.
Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.
Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Benefits

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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