Case Manager, Registered Nurse - Compact RN License Required (Remote)

CVS Health

1d•$60,522 - $129,615•Remote

About The Position

This is a fully remote, blended Case Management and Utilization Management role on Aetna’s National Medical Excellence team. The RN Case Manager assesses, plans, implements, and coordinates case management activities with members by telephone and/or face to face, evaluating medical needs to support members’ overall wellness. Applicants from any state may apply, with preference for candidates in compact RN states. The role uses clinical tools, information and data review, claims history, and member interviews to assess needs, benefit eligibility, health status, functional capacity, and conditions including comorbidities and multiple diagnoses. The Case Manager develops proactive plans, addresses risk factors and health or social barriers, facilitates integration with Aetna programs and transitions of care, and refers members to clinical resources when needed. The role also involves consultation with supervisors and colleagues, presenting cases at multidisciplinary case conferences, and following regulatory and company case management policies and procedures. This position is remote, with work required from the state and city where the colleague has confirmed they live. The colleague must maintain a quiet, secure, private home workspace compliant with CVS Health and HIPAA requirements, and provide workspace furniture. A direct, hardwired internet connection is required, with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. CVS Health provides computer equipment and related peripherals. The schedule is Monday through Friday, 8 a.m. to 5 p.m. in the employee’s resident time zone; the posting notes there are currently no nights, weekends, or holidays, though this may change based on business needs.

Requirements

Active, current, unrestricted compact Registered Nurse (RN) license in the state of residence.
Five years of clinical practice experience as a Registered Nurse.
At least two years of critical care experience.
At least six months of case management or utilization management experience.
Ability to work Monday through Friday, 8 a.m. to 5 p.m. in the time zone of residence; schedule may change based on business needs.
Ability to obtain multistate RN licenses.
Associate’s degree in Nursing.
Ability to obtain and maintain a direct, hardwired internet connection to a modem or router within seven feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Quiet, secure, private, designated home work location that is compliant with CVS Health and HIPAA guidelines and permits uninterrupted work.
Ability to work within the state and city where the employee has confirmed they currently live.
Provide personal workspace furniture, such as a desk or standing desk, and meet the stated work-from-home requirements.
Comfort using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate using email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to use secure systems such as VPNs and EHR portals and follow basic computer and account security practices.
Ability to resolve common technical issues independently and contact IT for issues that cannot be resolved.

Nice To Haves

Case Management Certification.
Transplant experience.
Bachelor’s degree in Nursing.

Responsibilities

Assess, plan, implement, and coordinate case management activities with members by telephone and/or face to face.
Develop proactive courses of action to address issues and improve short- and long-term outcomes and overall member wellness.
Use clinical tools and information or data review to evaluate member needs and benefit eligibility and facilitate integration and transitions to Aetna programs and plans.
Apply clinical judgment to strategies that reduce risk factors and barriers and address complex health and social indicators affecting care planning and resolution.
Assess all conditions, including comorbidities and multiple diagnoses that affect functionality, using information from multiple sources.
Review prior claims for potential effects on current case management and eligibility.
Assess members’ work capacity and related restrictions or limitations.
Use a holistic approach to determine whether referrals to clinical resources are needed to assess functionality.
Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at multidisciplinary case conferences.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Use interviewing skills to engage members and determine their health status and needs through questions and conversation.