Case Manager Registered Nurse (Illinois)

CVS Health•Peoria, IL

3d•$66,575 - $142,576•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Must reside in Illinois and possess IL RN License Program Overview Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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. A Brief Overview Administers processes to coordinate and facilitate comprehensive care for individuals by assessing their needs, developing personalized care plans, and coordinating services across healthcare providers. Serves as advocate for patients, ensuring effective communication, resource utilization, and continuous monitoring of their progress to promote positive outcomes and enhance overall well-being. What you will do Administers the care coordination plan to assess patient needs and ensure seamless transitions between different care settings. Analyzes complex patient data from medical history, diagnostic test results, and treatment plans, to understand the current health status of the patient. Applies in-depth knowledge of case management to organize patient files in an orderly manner for easy retrieval. Communicates through internal platforms to securely exchange messages, conduct video conferences, share files, and collaborate on patient care plans. Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. Configures the case management system to organize cases dealing with disease management and utilization review; tracks patient progress and manages specific conditions. Coordinates analytics projects to enable case managers to analyze data and generate reports on key performance health indicators. Designs complex processes to coordinate discharge planning in a safe and timely transition from the hospital to home. Develops resource management to help case managers optimize healthcare with community resources.

Requirements

Must reside in Illinois and possess IL RN License
3-5 years of direct clinical practice experience e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Efficient and Effective computer skills including navigating multiple systems and keyboarding
Associate's Required
Active and Unencumbered Registered Nurse License in Illinois

Nice To Haves

Case management and discharge planning experience
Managed care/utilization review experience
Crisis intervention skills
Certified Case Manager
Bilingual

Responsibilities

Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.