Case Manager Registered Nurse (Remote)

CVS Health

1d • Remote

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. Position Summary Location: This role will be work at home with less than 5% travel that may be required in the event of clinical audits. Schedule: Monday-Friday 8:00am-4:30pm in the time zone of residence with occasional late shift rotation until 8:00pm. There are no weekends or holiday shifts required at this time. The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. This Case Manager RN role is 100% remote, and the employee can live in any state and telework, however, there is a preference for an RN in a Compact RN state.

Requirements

• Must have an active current and unrestricted RN license in state of residence.
• Willingness and ability to obtain additional state licenses upon hire (paid for by the company).
• 3+ years of clinical experience as an RN.
• Candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Nice To Haves

• Compact RN licensure.
• Ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills.
• Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills.
• Managed Care experience prior experience within a telephonic customer service center type of environment is preferred.
• Candidate must possess good computer skills.

Responsibilities

• Assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.
• The responsibilities of this position are to apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.
• Conducts comprehensive clinical assessments.
• Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services.
• Advocates for patients to the full extent of existing health care coverage.
• Promotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency.
• Identifies and escalates quality of care issues through established channels.
• Expectation is a very high level of customer service.
• Utilizes assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree