Case Manager RN (Remote)

CVS Health

20h•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. This Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states. Normal Working Hours: Monday-Friday with earliest start time being 9:00am in the time zone of residence. Team is open to varying hours until 8:00pm EST. There is a late shift rotation until 8:00pm EST with the potential of holiday on-call as needed. There is no travel expected with this position.

Requirements

Registered Nurse with active and unrestricted RN licensure in their state of residence, preferably with multi-state/compact privileges.
Must have the ability to be licensed in all non-compact states
3+ years clinical practice experience required

Nice To Haves

Compact RN licensure
Case management experience
Case Manager Certification
Experience with using Windows / Microsoft Office
Strong computer skills

Responsibilities

Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Reviews prior claims to address potential impact on current case management and eligibility.
Assessments include the member’s level of work capacity and related restrictions/limitations.
Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.