Case Manager RN

CVS Health

23d•Remote

About The Position

CVS Health is building a world of health around every individual, shaping a more connected, convenient, and compassionate health experience. Colleagues are passionate, innovative, accountable, and prioritize safety and quality. This 100% remote Case Manager RN position involves no travel and operates Monday through Friday, 8-hour shifts between 7am to 5pm Arizona time. The Nurse Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating case management activities for members from Federal Plans. The role evaluates members' medical needs to promote overall wellness, develops proactive action plans for short and long-term outcomes, and applies data-driven methods for individualized case management programs or referrals. Key tasks include conducting comprehensive clinical assessments, developing flexible approaches based on member needs and benefits, advocating for patients within their coverage, promoting quality and cost-effective outcomes, identifying and escalating quality of care issues, and providing high-level customer service. The Case Manager will also utilize assessment techniques to determine health literacy, technology capabilities, and readiness to change, and employ influencing/ motivational interviewing skills to maximize member engagement and promote lifestyle/behavior changes for optimum health.

Requirements

Active, current and unrestricted RN licensure in state of residence and have the ability to be licensed in all non-compact states
Willing and able to work Monday through Friday, 8 hour shift between 7am to 5pm Arizona time
Must live in either PST, MST, or Arizona Time zones
3+ years of clinical practice experience
1+ years of experience utilizing MS Office suites
Associate's degree

Nice To Haves

Case management experience
Case Manager Certification
BSN preferred

Responsibilities

Telephonically assess, plan, implement and coordinate all case management activities with members from Federal Plans
Evaluate the medical needs of the member in order to facilitate and promote the member’s overall wellness
Develop a proactive course of action to address issues presented to enhance the member's short and long term outcomes
Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs
Conduct comprehensive clinical assessments
Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services
Advocate for patients to the full extent of existing health care coverage
Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency
Identify and escalate quality of care issues through established channels
Provide an expected very high level of customer service
Utilize assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change
Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health