Case Manager Registered Nurse
About The Position
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. This Case Manager RN position is 100% remote and the employee can live in any state. Normal Working Hours: Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30am-7pm EST (1-2 times per quarter). Typical training hours are Monday-Friday 8-4:30 EST. Nurse Care Manager is responsible for telephonically and/or face to face 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. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies. 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 MI skills to ensure maximum member engagement and discern their health status.
Requirements
- Must have an active current and unrestricted RN license in state of residence.
- With the willingness and ability to obtain additional state licenses upon hire (paid for by the company)
- 5+ years of acute care experience as an RN
- Must be willing and able to work Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30AM to 7PM EST
- Strong computer skills Microsoft Suite familiarity
Nice To Haves
- Compact State licensure
- CCM certification
- Experience in care case management
- Home Care experience
- Spanish speaking/bilingual
- Oncology experience/background
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
