SKY Complex Care Manager- Case Manager RN- Field (Northern Bluegrass Region)

CVS Health • KY

95d • $54,095 - $116,760

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. The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member’s improved health. The Case Manager 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. Services strategies policies and programs are comprised of network management and clinical coverage policies. This is a field-based position that requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training. This position is assigned to the Northern Bluegrass Region. Qualified candidates must reside in one of the counties within the specified region (Boone, Bourbon, Campbell, Carroll, Gallatin, Grant, Harrison, Kenton, Nichols, Owen, Pendleton, and Scott).

Requirements

• 3+ years’ clinical practice experience including patient care coordination and health assessments.
• RN with current unrestricted state licensure required.
• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications.
• Must possess reliable transportation and be willing and able to travel in-state up to 80-90% of the time.
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required.
• Candidate must reside in the specific counties of the services region.

Nice To Haves

• Experience or detailed knowledge of the Foster Care and juvenile justice systems.
• Clinical experience and demonstrated knowledge of age appropriate developmental milestones.
• Clinical experience and understanding of complex medical conditions and treatment plans.
• Case Management in an integrated model preferred.
• Discharge Planning Experience.
• Bilingual preferred.
• BSN preferred.

Responsibilities

• Conduct comprehensive and holistic evaluation of member's needs and benefit plan eligibility.
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers.
• Integrate assessment data from all care partners to address all physical and behavioral health conditions.
• Create, monitor and revise member care plans to address member biopsychosocial care needs.
• Review prior claims to address potential impact on current case management and eligibility.
• Assess the member’s functional capacity and related restrictions/limitations.
• Consult with supervisor and other care partners to overcome barriers in meeting goals and objectives.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Utilize motivational interviewing skills to ensure maximum member engagement.
• Help member actively participate with their provider in healthcare decision-making.

Benefits

• Affordable medical plan options.
• 401(k) plan (including matching company contributions).
• Employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs.
• Confidential counseling and financial coaching.
• Paid time off.
• Flexible work schedules.
• Family leave.
• Dependent care resources.
• Colleague assistance programs.
• Tuition assistance.
• Retiree medical access.

What This Job Offers

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