Case Manager RN

1 week ago


Independence, Missouri, United States CVS Health Full time
Job Summary

This is a remote work from home role anywhere in the US with virtual training.

Shift is 8:30 am to 5 pm in your time zone.

Job Responsibilities
  • Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
  • 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality
  • Consults 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
  • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
  • 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 conversations
  • Identifies and escalates member's needs appropriately following set guidelines and protocols
  • Need to actively reach out to members to collaborate/guide their care
  • Perform medical necessity reviews
Requirements
  • 5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty
  • A Registered Nurse that holds an unrestricted license in their state of residence, and will to get a multi-state/compact privileges and can be licensed in all non-compact states
  • 1+ years' experience documenting electronically using keyboard and multiple computer screens as well as free form text with good typing skills
  • 1+ years' current or previous experience in Oncology, Behavioral Health/Substance Abuse, Maternity, Transplant or Medical/Surgical
Preferred Qualifications
  • 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
  • 1+ years' experience in Utilization Review
  • CCM and/or other URAC recognized accreditation preferred
  • 1+ years' experience with MCG, NCCN and/or Lexicomp
  • Bilingual preferably Spanish
Education
  • Diploma or Associates Degree in Nursing or higher


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