Care Manager Rn

4 weeks ago

Phoenix, United States CVS Health Full time

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

**Position Summary**

Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of the adult population.

The Nurse Case Manager is a full-time teleworker position that requires some travel. You will be responsible for telephonically and/or face to face 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. You will develop 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. Services, strategies, policies, and programs are comprised of network management and clinical coverage policies.

At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of the adult population who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 we began delivering integrated physical and behavioral health services to adults. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona.

**Fundamental Components**
- Using 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 take into account 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, assesses 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.
- Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
- Multitasks, prioritizes and effectively adapts to a fast-paced changing environment.
- Demonstrates proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Demonstrates effective communication skills, both verbal and written.
- Typical office working environment with productivity and quality expectations.

**Required Qualifications**
- RN with current unrestricted state licensure required.
- 2+ years of experience working with adult populations
- 5+ years’ clinical practice experience.
- Must be Arizona based and willing and able to travel 10% of the time in Maricopa County. (Mileage will be reimbursed per company policy.)

**Preferred Qualifications**
- Case Management in an integrated model **highly preferred.**
- Bilingual in Spanish preferred.
- Bachelor's Degree preferred

**Education**
- Minimum of an associates degree required

**Pay Range**

The typical pay range for this role is:
$60,522.80 - $129,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job

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