Clinical Case Manager RN
1 week ago
CVS Health is seeking a skilled Clinical Case Manager RN to join our team. As a Clinical Case Manager RN, you will work with patients and their care teams to provide comprehensive care management services. This is a remote work-from-home role, and you will have the flexibility to work from anywhere in the US with virtual training.
Key Responsibilities- Work intensely as a telephonic case manager with patients and their care teams 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
- 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
- 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
- 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting
- A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states
- 1+ years' experience documenting electronically using a keyboard
- 1+ years' current or previous experience in Oncology, Behavioral Health/Substance Abuse, Maternity, Maternal Newborn, Transplant, Pediatric, Medical/Surgical, or Specialty Pharmacy
- 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 in Spanish preferred
- Diploma or Associates Degree in Nursing required
- BSN preferred
CVS Health offers a competitive salary range of $54,095.60 - $116,760.80, as well as a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer paid time off, paid holidays, and a CVS store discount. If you are a motivated and compassionate Registered Nurse with a passion for delivering exceptional patient care, we encourage you to apply for this exciting opportunity.
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