Case Manager Registered Nurse - Field In Northern Forth Smith

CVS Health•Birdsboro, PA

1d•Hybrid

About The Position

This is a work from home flexible position with expected travel of up to 60% that will require home visit to members in the assigned areas of Keller, Roanoke, Richland Hills, River Oaks, North of Fort Worth, TX. The schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST. The role involves developing, implementing, supporting, and promoting health service strategies, tactics, policies, and programs to drive the delivery of quality healthcare to members, encompassing utilization management, quality management, network management, clinical coverage, and policies. The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, and psychosocial wrap-around services. The Case Manager is responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing, and communication skills are required. The Case Manager conducts face-to-face visits in members' homes using comprehensive assessment tools for members enrolled in Long-Term Services and Support programs. They coordinate and collaborate care with the member/authorized representative, PCP, and other care team participants, schedule and attend interdisciplinary meetings, and advocate on the member's behalf to ensure proper and safe discharge with appropriate services. The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the LTSS benefit, documenting accurately and timely in the member’s electronic health record. This position requires critical thinking skills and the ability to problem solve.

Requirements

Active and unrestricted RN license in the state of TX.
Minimum 2 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care.
Willing and able to travel up to 50% of their time meet members face to face in Dallas/Tarrant counties of TX and surrounding counties/ areas.
Reliable transportation required.
Associate degree required.

Nice To Haves

1 year experience of Case Management.
Managed care organization (MCO) experience.
Pediatric experience.
Star Kids experience.
Bilingual preferred (Spanish).
BSN preferred.

Responsibilities

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members.
Utilize advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, psychosocial wrap around services.
Conduct care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner.
Conduct face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Long-Term Services and Support programs.
Coordinate and collaborate care with the member/authorized representative, PCP, and any other care team participants.
Schedule and attend interdisciplinary meetings and advocate on the members behalf to ensure proper and safe discharge with appropriate services in place.
Work with the member and care team to develop a care plan and authorize services in a cost-effective manner within the LTSS benefit.
Document accurately and timely in the member’s electronic health record.
Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
Identify high risk factors and service needs that may impact members outcome and care planning components with appropriate referrals.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Use a holistic approach to overcome barriers to meet goals and objectives; present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identify and escalate quality of care issues through established channels.
Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Utilize influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Help member actively and knowledgeably participate with their provider in healthcare decision-making.