Case Manager, Registered Nurse/Licensed Practical Nurse - Field - Virginia

CVS Health-posted 3 months ago
$60,522 - $129,615/Yr
Full-time • Mid Level
Springfield, VA
5,001-10,000 employees
Ambulatory Health Care Services
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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. This Case Manager RN/LPN position is a field-based position out of Virginia; specifically the Alexandria, Arlington, Falls Church, Springfield and surrounding areas. The requirement is for candidates to hold a current unrestricted Virginia State RN, LPN or BH License, and travel 50-75% of the time to meet with members 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.
  • 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 facilitating 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.
  • Assessing the member's level of work capacity and related restrictions/limitations.
  • Reviewing prior claims to address potential impact on current case management and eligibility.
  • Using a holistic approach to assess 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.
  • Current unrestricted Virginia State RN, LPN or BH License required.
  • 3 years clinical experience in Med Surg and/or Behavioral Health or other similar fields.
  • Must reside in either Alexandria, Arlington, Falls Church, Springfield, Virginia or surrounding areas.
  • Current Virginia Driver's License.
  • Must possess reliable transportation and be willing and able to travel up to 50%-75% of the time.
  • 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.
  • Managed Care and Integrated model Case Management experience.
  • Bilingual.
  • Affordable medical plan options.
  • 401(k) plan (including matching company contributions).
  • 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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