Case Manager Registered Nurse (Remote)

CVS Health•Work At Home-Ohio, OH

4d•$60,522 - $129,615•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. 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. 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.

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.
Candidate must possess good computer skills.

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.

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.
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.
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.