Case Manager - Registered Nurse

CVS Health•New York, NY

2d•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. The Community Care Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Requirements

Candidate must have active and unrestricted Compact Registered Nurse (RN) License in their state of residence
3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
Associate's Degree or Nursing Diploma (REQUIRED)
Active and unrestricted Compact Registered Nurse (RN) License in their state of residence

Nice To Haves

2+ years case management, discharge planning and/or home health care coordination experience
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently (may require working from home)
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Efficient and effective computer skills including navigating multiple systems and keyboarding
Willing and able to obtain single state Registered Nurse (RN) licensure if needed
Bilingual
Certified Case Manager
National professional certification (CRC, CDMS, CRRN, COHN, or CCM)
Bachelor’s Degree (PREFERRED)

Responsibilities

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Acts as a liaison with member, family, provider(s), insurance companies, and healthcare personnel as appropriate.
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
Interacts with members/clients telephonically.
Assesses and analyzes injured, acute, or chronically ill members medical; develops a plan of care to facilitate the member appropriate condition management to optimize wellness and medical outcomes, or optimal functioning.