Care Manager RN
3 weeks ago
At CVS Health, we are committed to delivering enhanced human-centric healthcare for a rapidly changing world. As a Care Manager RN, you will play a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable.
Job Summary:The Care Manager RN will facilitate the delivery of appropriate benefits and/or healthcare information, which determines eligibility for benefits while promoting wellness activities. This role will develop, implement, and support Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and establish overall member wellness and successful and timely return to work.
Key Responsibilities:- Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
- Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician's office to provide ongoing case management services.
- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers, and insurance carriers) telephonically or in person.
- Prepares all required documentation of case work activities as appropriate.
- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
- Provides educational and prevention information for best medical outcomes.
- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
- Testifies as required to substantiate any relevant case work or reports.
- Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
- Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member's/client's overall wellness through integration.
- Monitors member/client progress toward desired outcomes through assessment and evaluation.
- Active TX Compact license
- Minimum 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
- Minimum 2+ years CM, discharge planning, and/or home health care coordination experience
- Up to 55-75% travel to the Houston Methodist Hospital
- Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills
- Associate's degree or Nursing Diploma Required
- Bachelor's degree Preferred
The typical pay range for this role is: $60, $129,615.20
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.
For more detailed information on available benefits, please visit Benefits | CVS Health
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