Case Manager Registered Nurse - Field in Northern Suburbs or Chicago Illinios

CVS Health•Shorewood, IL

10d

About The Position

The Nurse Case Manager coordinates telephonic and face-to-face case management activities with members, evaluating their medical needs and facilitating overall wellness. This field-based position requires 50–75% travel to meet members in Chicago’s northern suburbs. The nurse must reside in the northern suburbs of Chicago or surrounding areas listed in the posting. The schedule is Monday through Friday, 8:00 a.m.–5:00 p.m. CST. The role develops proactive strategies to address member needs and improve short- and long-term outcomes. It uses clinical tools, information and data review, and clinical judgment to evaluate needs, benefit eligibility, risk factors, barriers, and complex health and social indicators. The nurse coordinates care and transitions to Aetna programs and plans, follows network management and clinical coverage policies, and applies a holistic approach to care planning. Assessments consider co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions or limitations. The nurse may refer members to clinical resources, consult with supervisors and others to overcome barriers, present cases at multidisciplinary conferences, and use interviewing skills to engage members and understand their health status and needs. Case management processes must comply with regulatory and company policies and procedures.

Requirements

At least 3 years of clinical practice experience.
At least 1 year of experience using Microsoft Office suite applications.
Current, active, unrestricted RN licensure in Illinois.
Willingness and ability to travel 50–75% of the time to meet members face-to-face in Chicago’s northern suburbs.
Reliable transportation.
Associate degree with RN licensure.

Nice To Haves

Case management experience in an integrated model.
Experience working with adults with behavioral health needs.
Bachelor of Science in Nursing.

Responsibilities

Coordinate telephonic and face-to-face case management activities with members to evaluate medical needs and facilitate overall wellness.
Develop proactive strategies to address issues, improve short- and long-term outcomes, and identify opportunities to enhance member wellness through integration.
Use clinical tools and information or data review to evaluate member needs and benefit-plan eligibility and facilitate integrative functions 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 of member issues.
Conduct assessments that consider all conditions, including co-morbidities and multiple diagnoses that affect functionality.
Review prior claims for potential impacts on current case management and eligibility.
Assess members’ work capacity and related restrictions or limitations.
Use a holistic approach to assess whether referrals to clinical resources are needed to help determine 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 and company policies and procedures.
Use interviewing skills to engage members and discern their health status and needs.
Travel 50–75% of the time to meet members face-to-face in Chicago’s northern suburbs.