Case Manager RN- Field

Aetna Medicaid Administrators

37d

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

Requirements

• Must reside in Louisiana in one of the following parishes: Plaquemines, Jefferson, Orleans, St. Bernard, West Feliciana, East Feliciana, Pointe Coupee, West Baton Rouge, East Baton Rouge, Iberville, Ascension, St. Mary, Assumption, St. James, Terrebonne, Lafourche, St. Charles, St. John, Winn, Grant, Rapides, Vernon, LaSalle, Avoyelles, Catahoula, Concordia, Union, Lincoln, Jackson, Morehouse, Ouachita, Caldwell, West Carroll, Richland, Franklin, East Carroll, Madison, Tensas, St. Helena, Livingston, Tangipahoa, St. Tammany, Washington
• Registered Nurse with current unrestricted Louisiana (LA) license
• 3+ years' clinical practice experience as an RN
• 1+ years' Case management and discharge planning experience
• Must possess reliable transportation and be willing and able to travel, up to 75% or more of the time. Mileage is reimbursed per our company expense reimbursement policy.
• Proficiency with MS Office Suite (Outlook, Word, Excel, SharePoint, Teams), EMR systems, and multi-system navigation.
• Strong organizational skills with attention to detail, quality, and time management.
• Demonstrated ability to build and sustain a positive work culture that promotes engagement.
• Mastery in problem-solving, decision-making, collaboration, and execution.
• Knowledge of care transition phases and available member resources.
• Digital literacy and ability to leverage technology for operational efficiency.

Nice To Haves

• Medicaid experience
• Behavioral health experience
• Managed care/utilization review experience
• Waiver experience
• Crisis intervention skills
• Certified Case Manager (CCM) certification
• Familiarity with EMR
• BSN preferred

Responsibilities

• Coordinates all case management activities with members to evaluate medical needs
• Facilitate the overall wellness of members
• Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration
• Instructs programs and procedures in compliance with network management and clinical coverage policies

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree