Maternity Case Manager Registered Nurse

CVS Health

3d • $54,095 - $142,576 • 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. Position Summary Normal Working Hours: Monday through Friday 8:00am-4:30pm in time zone of Residence There are no weekend hours. There are no holiday coverage hours. There is no travel. This is a 100% remote work from home position and candidates from any state with a compact RN license can apply. This position is for high-risk maternity case management team and experience with this is required. The Case Manager RN is responsible for telephonic assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey. The Case Manager RN 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. The Case Manager RN includes some of the following roles (not all inclusive): -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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Requirements

• Must hold an active and unrestricted RN License.
• Applicants must be willing and able to pursue multi-state licensure (paid for by the company) as well as additional single state licenses.
• Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, infertility, maternity and/or OB-GYN office setting.

Nice To Haves

• Preferred RN licensure in a compact state
• 1+ years of Case Management experience in an integrated model
• 1+ years of experience with Telephonic Case Management
• Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
• Certified Case Manager (CCM) certification

Responsibilities

• 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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

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