RN Case Manager

4 weeks ago

Salt Lake, Utah, United States CVS Health Full time

Job Summary:

The RN Case Manager is a critical role at CVS Health, 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 functions as well as smooth transition to Aetna 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 member issues.
  • Assessments consider 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.
  • Assessments include the 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.
  • 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.

Requirements:

Registered Nurse with active and unrestricted RN licensure in their state of residence, preferably with multi-state/compact privileges. Must have the ability to be licensed in all non-compact states.

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.

Education:

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.

Work Environment:

Monday-Friday 8-4:30 in time zone of residence. Late shift rotation until 8pm EST approximately 1-2 times per month.

CVS Health:

At CVS Health, we put our heart into caring for our colleagues and our communities. We are an equal opportunity and affirmative action employer. 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.

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