Women's Health

CVS Health•Work At Home-Arizona, AZ

3d•$54,095 - $142,576•Remote

About The Position

The Case Manager RN works on a NICU/high-risk maternity case management team, assessing, planning, implementing, and coordinating case management activities telephonically and/or face to face. The role evaluates members’ medical needs and supports their overall wellness throughout their NICU and/or maternity journey. The Case Manager develops proactive plans to address issues, improve short- and long-term outcomes, and identify opportunities to enhance wellness through integration. The position is fully remote and works Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s local time zone. There are no weekend or holiday coverage hours and no travel. Applicants from any state with a compact RN license may apply. The role uses clinical tools and information review to assess member needs and benefit eligibility, facilitate integration and transitions to Aetna programs, address risk factors and barriers, and consider complex health and social indicators. Assessments draw on multiple sources to address co-morbidities and multiple diagnoses, review prior claims, consider work capacity and restrictions, and identify referrals to clinical resources. The Case Manager consults with supervisors and colleagues, presents cases at multidisciplinary conferences, follows regulatory and company policies and procedures, and uses interviewing skills to engage members and understand their health status and needs. Work-from-home requirements include a direct wired internet connection to a modem/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. The employee must maintain a quiet, secure, private, organized home workspace compliant with company and HIPAA guidelines and work from the state and city where they currently reside. The company provides computer equipment, while the employee provides workspace furniture. The position requires extended desk work and the ability to use multiple monitors and applications, digital communication and collaboration tools, secure systems, and basic troubleshooting procedures. The employee must follow security practices and be open to learning new skills as the workplace evolves.

Requirements

Active and unrestricted RN license.
Willingness and ability to pursue multi-state licensure; the company pays for it.
At least 3 years of clinical RN experience in a NICU setting.
Associate degree in Nursing.
Ability to meet work-from-home internet, workspace, residency, and security requirements.
Ability to navigate multiple monitors and applications, communicate using digital tools, access secure systems, and troubleshoot common technical issues.

Nice To Haves

RN licensure in a compact state.
Clinical RN experience in an inpatient or outpatient setting focused on women’s health, infertility, maternity, and/or an OB-GYN office.
At least 1 year of Case Management experience in an integrated model.
At least 1 year of experience with Telephonic Case Management.
Experience with Microsoft Office, including PowerPoint, Excel, and Word.
Certified Case Manager (CCM) certification.
Experience with ATV/ASD.
Bachelor of Science in Nursing.

Responsibilities

Assess, plan, implement, and coordinate case management activities telephonically and/or face to face to evaluate members’ medical needs and support overall wellness.
Develop proactive courses of action to address issues and improve short- and long-term outcomes.
Use clinical tools and review information and data to assess member needs and benefit-plan eligibility, facilitate integration, and support transitions to Aetna programs and plans.
Apply clinical judgment to address risk factors, barriers, and complex health and social indicators that affect care planning and resolution of member issues.
Assess conditions, including co-morbidities and multiple diagnoses, using information from various sources.
Review prior claims for potential impact on current case management and eligibility.
Assess members’ work capacity and related restrictions or limitations.
Use a holistic approach to determine whether referral to clinical resources is appropriate 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 understand their health status and needs.