Case Manager RN
6 days ago
CVS Health is seeking a skilled Case Manager RN to join our team. As a Case Manager RN, you will be responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate their overall wellness.
Key Responsibilities- Develop 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.
- Conduct an evaluation of member's needs and benefit plan eligibility and facilitate integrative function as well as smooth transition to Aetna's programs and plans.
- Apply 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 members' issues.
- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnosis that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessments include member's level of work capacity and related restrictions/limitations.
- Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
- Consults with supervisor and others in overcoming barriers and meeting goals and objectives, presents cases at case conference 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.
- Must have an active current and unrestricted RN licensure in the state of residence.
- Must be willing to obtain multiple state RN licensure after hire (expenses paid for by company).
- 2+ years as an RN with med/surge experience Emergency Department, and Telemetry.
- Must be willing to work Monday - Friday 9:00am - 5:30pm.
- Must be willing to work late shift once per quarter until 9pm.
- 1+ year experience with all types of Microsoft Office including Power Point, Excel, and Word.
- 2+ years of Case Management experience.
- Strong telephonic communication skills.
- Certified Case Manager (CCM) certification.
- Associates degree in Nursing.
- BSN preferred.
The typical pay range for this role is: $66,575.08 - $142,576.72. 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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