Nurse Case Manager
1 day ago
At CVS Health, we're committed to delivering exceptional patient care and innovative solutions that make healthcare more personal, convenient, and affordable. We're seeking a skilled Nurse Case Manager to join our Community Care team, where you'll play a vital role in shaping the future of healthcare.
About the RoleAs a Nurse Case Manager, you'll collaborate with members, providers, and community organizations to address the full continuum of healthcare and social determinants needs. Your expertise will help us elevate patient care to new heights, ensuring timely and effective interventions that promote optimal wellness and medical outcomes.
Key Responsibilities- Act as a liaison with members, providers, and healthcare personnel to coordinate care and services.
- Implement and coordinate case management activities for catastrophic cases and chronically ill members, including consultant referrals, home care visits, and community resource utilization.
- Assess and analyze members' medical and vocational status, developing plans of care to optimize wellness and medical outcomes.
- Communicate with members and stakeholders, preparing required documentation and interacting with internal multidisciplinary teams to ensure seamless care coordination.
- Make outreach to treating physicians and specialists to discuss course of care and treatment.
- Provide educational and prevention information to promote best medical outcomes.
- Apply laws and regulations governing rehabilitation services, adhering to individual insurance carrier and referral source requirements.
- Testify as required to substantiate case work or reports.
- Conduct evaluations of members' needs and benefit plan eligibility, facilitating integrative functions using clinical tools and information/data.
- Utilize care management processes in compliance with regulatory and company policies and procedures.
- Active and unrestricted NJ RN Compact License.
- Must reside in NJ.
- Minimum 3+ years clinical practice experience.
- Minimum 2+ years Case Management, discharge planning, and/or home health care coordination experience.
- Ability to occasionally travel up to 25% within a designated geographic area for in-person case management activities.
- Minimum 2+ years proficiency with standard corporate software applications, including MS Word, Teams, Excel, Outlook, and PowerPoint.
- Experience working with Medicare members with diabetes, CHF, CKD, post-acute care, hospice, palliative care, and/or cardiac conditions.
- Managed care experience.
- Willingness to obtain additional state RN licenses if needed, company-paid.
- Excellent analytical and problem-solving skills.
- Effective communications, organizational, and interpersonal skills.
- Ability to work independently, remotely, and field-based.
- Efficient and effective computer skills, including navigating multiple systems and keyboarding.
As a CVS Health employee, you'll enjoy a comprehensive benefits package, including medical, dental, and vision coverage, 401(k) retirement savings plan, and employee stock purchase plan. You'll also have access to free development courses, CVS store discounts, and discount programs with participating partners.
Join our team and be part of a company that puts its heart into caring for its colleagues and communities. Apply now to become a part of our mission to transform patient care and make healthcare more personal, convenient, and affordable.
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