Case Manager, Registered Nurse

CVS Health•Work At Home-Illinois, IL

1d•$66,575 - $142,576•Remote

About The Position

The Community Care Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to identify options and services that address individuals’ and families’ comprehensive health needs. The role uses communication and available resources to promote quality, cost-effective outcomes. The position facilitates the delivery of appropriate benefits and healthcare information, determines benefit eligibility, promotes wellness, and supports health strategies and programs intended to improve member wellness and successful, timely return to work. Case managers coordinate care for catastrophic cases and chronically ill members across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care. Interactions may take place by telephone or in person, including in members’ homes, worksites, or physicians’ offices. This is a full-time, work-from-home position. The employee must work from the state and city where they have confirmed residence, maintain a quiet and secure private workspace, and meet specified hardwired internet requirements. The company provides computer equipment and related peripherals; the employee provides workspace furniture. The position is scheduled for 40 hours per week.

Requirements

Active and unrestricted Illinois Registered Nurse (RN) license.
At least 2 years of experience in case management, discharge planning, and/or home health care coordination.
Associate’s degree or nursing diploma.
Ability to meet work-from-home requirements, including a direct hardwired internet connection within 7 feet of the computer, minimum speeds of 25 Mbps download and 3 Mbps upload, and a quiet, secure, private workspace compliant with CVS Health and HIPAA guidelines.
Must work from the state and city where the employee has confirmed current residence.
Ability to use multiple monitors and applications simultaneously and communicate through email, calendar invites, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 or similar applications and access secure systems such as VPNs and EHR portals while following computer and account security practices.
Ability to resolve common technical issues independently and contact IT for issues that cannot be resolved.
Commitment to obtain the required internet speeds and comply with work-from-home requirements if hired.

Nice To Haves

Three or more years of clinical practical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care with Medicare members.
Bachelor’s degree.
Ability to travel occasionally within a designated geographic area for in-person case management activities as directed by leadership or business needs.
Spanish bilingual ability.
Strong analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Ability to work independently, potentially from home.
Proficiency with Microsoft Word, Excel, Outlook, and PowerPoint, as well as proprietary applications.
Efficient computer skills, including navigating multiple systems and keyboarding.
Willingness and ability to obtain multistate Registered Nurse licenses if needed; the company will provide them if needed.
Certified Case Manager credential.
National professional certification such as CRC, CDMS, CRRN, COHN, or CCM.

Responsibilities

Serve as a liaison among members, clients, families, employers, providers, insurance companies, and healthcare personnel.
Implement and coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care.
Interact with members and clients by telephone or in person, including meeting in homes, worksites, or physicians’ offices when required.
Assess and analyze members’ or clients’ medical and/or vocational status and develop plans of care to support appropriate condition management, wellness, medical outcomes, timely return to work, and benefit eligibility determinations as appropriate.
Communicate with members and other stakeholders, including medical providers, attorneys, employers, and insurance carriers.
Prepare required documentation of casework activities.
Consult with internal multidisciplinary teams to help members achieve the best health outcomes.
Contact treating physicians or specialists regarding the course of care and treatment as appropriate.
Provide educational and prevention information to support optimal medical outcomes.
Apply laws and regulations governing rehabilitation services and special instructions from insurance carriers and referral sources.
Evaluate members’ needs and benefit-plan eligibility and facilitate integrated functions using clinical tools and information or data.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Facilitate condition management, overall wellness, medical outcomes, return to baseline, optimal functioning, or return to work.
Develop proactive courses of action to address issues, improve short- and long-term outcomes, and identify opportunities to enhance members’ overall wellness through integration.
Monitor member progress toward desired outcomes through assessment and evaluation.