Case Manager - Registered Nurse - South Region

CVS Health•Work At Home-Ohio, SC

10d•$60,522 - $129,615•Remote

About The Position

The Community Care Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals’ and families’ comprehensive health needs and promote quality, cost-effective outcomes. The role acts as a liaison among members or clients and their families, employers, providers, insurers, and other healthcare personnel. The Case Manager coordinates case management activities for catastrophic cases and chronically ill members across the continuum of care. This may involve consultant referrals, home care visits, community resources, and alternative levels of care. The position interacts with members by phone and in person, including possible visits to homes, worksites, or physicians’ offices. It assesses medical and/or vocational status, develops care plans, supports condition management and wellness, and helps facilitate timely return to work or optimal functioning and benefit eligibility determinations as appropriate. The role communicates with members and relevant stakeholders, documents case work, consults with multidisciplinary teams, may contact treating physicians or specialists, and provides education and prevention information. It applies relevant laws, regulations, carrier instructions, and company policies; may testify to substantiate case work or reports; evaluates needs and benefit eligibility; and monitors progress toward desired outcomes. This is a full-time, work-from-home position for candidates residing in the South Region states listed in the posting. The role requires a private, secure home workspace and a direct-wired internet connection meeting the stated speed requirements. The company provides equipment, while employees provide their own workspace furniture.

Requirements

Reside in the South Region: OH, VA, NC, KY, TN, SC, GA, AL, MS, AR, LA, or FL.
Have an active and unrestricted Compact Registered Nurse (RN) license in Ohio or the state of residence.
Have at least 2 years of case management, discharge planning, and/or home health care coordination experience.
Have an Associate’s Degree or Nursing Diploma.
Meet work-from-home requirements, including a direct-wired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private, distraction-free, tidy and organized home work location that complies with CVS Health and HIPAA guidelines and permits uninterrupted work.
Work from within the state and city where the employee has confirmed they currently live.
Provide workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
Commit to obtaining the required internet speeds and following all work-from-home requirements if hired.
Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
Be able to communicate through email, calendar invitations, Teams messaging, and virtual meetings.
Be able to use Microsoft Office 365 applications or similar tools such as Google Workspace.
Be able to access secure systems such as VPNs and EHR portals, secure devices and passwords, lock screens when unattended, and recognize suspicious emails or links.
Be able to troubleshoot common technical issues independently and contact IT for unresolved problems.

Nice To Haves

Three or more years of clinical practical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care with Medicare members.
Bilingual Spanish skills.
Excellent analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Ability to work independently, including potentially working from home.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, and proprietary applications.
Efficient computer skills, including navigating multiple systems and keyboarding.
Willingness and ability to obtain multistate RN licenses if needed; the company will provide support.
Certified Case Manager.
National professional certification such as CRC, CDMS, CRRN, COHN, or CCM.
Bachelor’s Degree.

Responsibilities

Assess, plan, facilitate, coordinate, evaluate, and advocate for services and resources to meet members’ and families’ comprehensive health needs.
Act as a liaison among members or clients, families, employers, healthcare providers, insurance companies, and other healthcare personnel.
Coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care.
Interact with members telephonically and in person, including possible visits to homes, worksites, or physicians’ offices.
Assess members’ medical and/or vocational status and develop care plans that support condition management, wellness, medical outcomes, return to work, or optimal functioning.
Communicate with members and stakeholders such as medical providers, attorneys, employers, and insurance carriers.
Prepare required documentation of case work activities.
Consult with internal multidisciplinary teams to help members achieve the best health outcomes.
Contact treating physicians or specialists regarding care and treatment as appropriate.
Provide education and prevention information to support medical outcomes.
Apply relevant laws, regulations, insurer instructions, referral-source instructions, and company policies and procedures.
Testify as required to substantiate relevant case work or reports.
Evaluate member needs and benefit-plan eligibility, and facilitate integrated care functions using clinical tools and information.
Develop proactive courses of action to address issues and improve short- and long-term outcomes and overall wellness.
Monitor member progress toward desired outcomes through assessment and evaluation.