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

CVS Health•Shorewood, IL

11d•$66,575 - $142,576•Onsite

About The Position

The Case Manager Registered Nurse coordinates telephonic and face-to-face case management activities with members to assess medical needs and support their overall wellness. The role develops proactive strategies to address member issues, improve short- and long-term outcomes, reduce risk factors and barriers, and support transitions to Aetna programs and plans. Assessments consider conditions and co-morbidities affecting functionality, benefit eligibility, prior claims, work capacity, restrictions, and limitations. The nurse uses clinical tools, information review, interviewing skills, and a holistic approach to identify needs and potential referrals to clinical resources. This is a field-based position serving the Northern suburbs of Chicago, with expected travel of 50–75% for in-person member visits. The employee must reside in the Northern suburbs of Chicago or surrounding areas. The schedule is Monday through Friday during standard business hours, 8:00 a.m.–5:00 p.m. CST. Reliable transportation is required, and mileage is reimbursed under the company expense reimbursement policy.

Requirements

At least 3 years of clinical practice experience.
At least 1 year of experience using MS Office suite applications.
Current, active, unrestricted RN license in Illinois.
Willingness and ability to travel 50–75% of the time for face-to-face member visits.
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

Assess, plan, implement, and coordinate case management activities by telephone and face to face to evaluate members’ medical needs and support their overall wellness.
Develop proactive strategies to address issues and improve short- and long-term outcomes and member wellness.
Use clinical tools and information or data review to evaluate member needs and benefit eligibility, facilitate integrative functions, and support transitions to Aetna programs and plans.
Apply clinical judgment to 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 affecting functionality.
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 assess the need for referrals to clinical resources to help determine functionality.
Consult with supervisors and others to overcome barriers; present cases at case conferences for multidisciplinary review and overall claim management.
Use case management processes in compliance with regulatory and company policies and procedures.
Use interviewing skills to engage members and determine their health status and needs through key questions and conversation.
Travel to meet members face to face in the Northern suburbs of Chicago.