Case Manager RN
3 weeks ago
CVS Health is seeking a highly skilled and compassionate Case Manager RN to join our team. As a Case Manager RN, you will play a vital role in assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate their overall wellness.
Key Responsibilities- Conduct face-to-face member visits to assess their needs and develop a proactive course of action to address issues presented.
- Use clinical tools and information/data review to evaluate member's needs and benefit plan eligibility, and facilitate integrative functions as well as smooth transition to Aetna programs and plans.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
- Assess information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Review prior claims to address potential impact on current case management and eligibility.
- Use a holistic approach to assess the need for a referral to clinical resources for assistance in determining functionality.
- Consult 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.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Utilize interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Registered Nurse with current unrestricted West Virginia (WV) license or Registered Nurse with current unrestricted WV 'multi-state privilege' license.
- 3+ years' clinical practice experience.
- 2+ years' experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams).
- Must possess reliable transportation and be willing and able to travel in the Southern Region of WV 50% or more, of the time. Mileage is reimbursed per our company expense reimbursement policy.
- Qualified candidates must reside in the region, in one of the following counties: Mingo, Logan, Boone, McDowell, Wyoming, Raleigh, Mercer, Summers, Monroe, Greenbrier, Pocahontas.
- Pediatric experience.
- Medicaid experience.
- Waiver experience.
- Foster care experience.
- Crisis intervention skills.
- Managed care/utilization review experience.
- Certified Case Manager (CCM) certification.
- Case management experience in an integrated model.
- Case management and discharge planning experience.
- Familiarity with QuickBase.
- Associate's or Diploma in Nursing required.
- BSN degree preferred.
The typical pay range for this role is: $54,095.60 - $116,760.80. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ('PTO') or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
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