Case Manager Registered Nurse - Field - Must reside in Woodbridge Virginia and Surrounding Areas.

CVS Health•McLean, VA

20h•Onsite

About The Position

This position is for a Case Manager Registered Nurse serving the Northern Virginia area, specifically requiring residence in Woodbridge or surrounding areas. The role operates Monday-Friday during standard business hours and involves both telephonic and face-to-face interactions with members. The Nurse Case Manager is responsible for assessing, planning, implementing, and coordinating all case management activities to evaluate members' medical needs and facilitate their overall wellness. This includes developing proactive courses of action, evaluating member needs and benefit plan eligibility, facilitating transitions to Aetna programs, and applying clinical judgment to address complex health and social indicators. The role involves reviewing prior claims, assessing work capacity, referring to clinical resources, consulting with supervisors, presenting cases at conferences, and utilizing case management processes in compliance with policies. Effective interviewing skills are crucial for member engagement and discerning health status.

Requirements

Current unrestricted Virginia state RN licensure
3+ years clinical experience as a Registered Nurse (i.e. med surg, behavioral health, acute care)
Must reside in Woodbridge Virginia and surrounding areas
Must be willing and able to travel up to 75% of the time to meet members in their home
Associate degree in Nursing

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
Proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written
Bachelor’s degree

Responsibilities

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
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