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Case Manager RN
4 months ago
Job Description
Prefers candidates residing in Cook County, IL.
Utilizes advanced clinical judgement and critical thinking
skills to facilitate appropriate member physical health and
behavioral healthcare through assessment and care
planning, direct provider coordination/collaboration, and
coordination of psychosocial wraparound services to
promote effective utilization resources and optimal, cost effective outcomes.
Assessment of Members: Through the use of clinical tools
and information/data review, conducts comprehensive
assessments of referred members needs/eligibility and
determines approach to case resolution and/or meeting
needs by evaluating members benefit plan and available
internal and external programs/services. Applies clinical
judgment to the incorporation of strategies designed to
reduce risk factors and address complex clinical indicators
which impact care planning and resolution of member
issues. Using advanced clinical skills, performs crisis
intervention with members experiencing a behavioral health
or medical crisis and refers them to the appropriate clinical
providers for thorough assessment and treatment, as
clinically indicated. Provides crisis follow up to members to
help ensure they are receiving the appropriate
treatment/services. Enhancement of Medical
Appropriateness and Quality of Care: Application and/or
interpretation of applicable criteria and clinical guidelines,
standardized case management plans, policies,
procedures, and regulatory standards while assessing
benefits and/or members needs to ensure appropriate
administration of benefits. Using holistic approach consults
with supervisors, Medical Directors and/or other programs
to overcome barriers to meeting goals and objectives;
presents cases at case conferences to obtain
multidisciplinary view in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through
established channels. Ability to speak to medical and
behavioral health professionals to influence appropriate
member care. -Utilizes influencing/motivational interviewing
skills to ensure maximum member engagement and
promotes lifestyle/behavior changes to achieve optimum
level of health. Provides coaching, information and support
to empower the member to make ongoing independent
medical and/or healthy lifestyle choices. Helps member
actively and knowledgably participate with their provider in
healthcare decision-making -Analyzes all utilization, self
report and clinical data available to consolidate information
and begin to identify comprehensive member needs.
Monitoring, Evaluation and Documentation of Care: In
collaboration with the member and their care team
develops and monitors established plans of care to meet
the members goals Utilizes case management and quality
management processes in compliance with regulatory and
accreditation guidelines and company policies and
procedures.
Pay Range
The typical pay range for this role is:
Minimum: 55,300
Maximum: 118,900
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls.
The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Minimum of 3 years of direct clinical practice experience (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)
-Must possess unencumbered RN license in the state of Illinois.
-Willing and able to travel up to 10% of their time using their own vehicle for onsite team meetings within the state of IL.
Preferred Qualifications
-Managed care/utilization review experience preferred
-Case management and discharge planning experience
preferred
Education
Minimum of a Associate degree required; BSN preferred.
Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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