Case Manager Registered Nurse

CVS Health•Work At Home-North Carolina, NC

9d•$54,095 - $116,760•Hybrid

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 Case Manager RN role is telework/hybrid and applicant must live in the state of North Carolina. Normal Working Hours: Monday through Friday 9:00am – 5:30pm EST. Occasional evening, weekend, and holiday shifts per the needs of the team. 0-10% travel possible including but not limited to travel to the High Point office for customer meetings. The RN Case Manager is responsible for telephonically 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.

Requirements

Must have an active and unrestricted RN license in the state of North Carolina.
Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company)
2+ years of clinical experience as an RN
All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.

Nice To Haves

Certified Case Manager (CCM) certification
3+ years’ experience with Microsoft Office Suite
Case Management in an integrated model
Discharge Planning experience
Managed care experience
BSN Education
Associates Degree in Nursing

Responsibilities

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.
Through the use of clinical tools and information/data review, 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.