Care Manager RN
2 weeks ago
Care Managers at CVS Health are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
Key Responsibilities- Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness.
- Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
- Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
- Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
- Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
- Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Registered Nurse with active Michigan state license in good standing
- Minimum 3+ years clinical practical experience as an RN required
- Minimum 2+ years in one or more of the following areas: Care Management, discharge planning, LTC (long term care), or home health care coordination experience required
- Ability to travel 25-50% within Kalamazoo and surrounding counties
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