Clinical Nurse Specialist

4 weeks ago

Salt Lake, Utah, United States CVS Health Full time

Job Summary:

The RN Case Manager is responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate their overall wellness.

Key Responsibilities:

  • Develops a proactive course of action to address issues presented to enhance short and long-term outcomes and opportunities to enhance a member's overall wellness through integration.
  • 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.
  • Assesses 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.
  • Assesses the member's level of work capacity and related restrictions/limitations.
  • Uses a holistic approach to 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 interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Requirements:

  • Registered Nurse with active and unrestricted RN licensure in their state of residence, preferably with multi-state/compact privileges.
  • 3+ years clinical practice experience as a Registered Nurse required.
  • Preference for those residing in PST or MST.
  • Compact RN licensure.
  • Case management experience.
  • Case Manager Certification.
  • Experience with using Windows/Microsoft Office.
  • Strong computer skills.
  • Effective communication, organizational, and interpersonal skills.
  • Associate's degree or nursing diploma required, Bachelor's degree preferred.

Benefits:

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.

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