Nurse Case Manager
1 month ago
The Complex Nurse Case Manager is a critical role at CVS Health, responsible for assessing members through regular and consistent in-person or telephonic contact to evaluate their medical and psychosocial needs. This position requires a proactive approach to address issues presented, enhance short and long-term outcomes, and support overall wellness. The ideal candidate will have a strong clinical background, excellent communication skills, and the ability to work independently in a field-based setting.
Key Responsibilities- Conduct comprehensive and holistic evaluations of members' needs, utilizing clinical assessment tools and evaluating information/data review.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers, addressing complex health and social indicators that impact care planning and resolution of member issues.
- Integrate assessment data from all care partners to holistically address physical and behavioral health conditions, including co-morbid and multiple diagnoses that impact functionality and member well-being.
- Create, monitor, and revise member care plans to comprehensively address biopsychosocial care needs.
- Review prior claims to address potential impact on current case management and eligibility.
- Assess members' functional capacity and related restrictions/limitations, using a holistic approach to determine the need for referrals to additional clinical resources.
- Consult with supervisors and other care partners to overcome barriers in meeting goals and objectives, presenting 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.
- Utilize motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Current unrestricted RN licensure in KY.
- 3+ years' clinical practice experience as an RN.
- 1+ years' experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations.
- 2+ years computer literacy and demonstrates proficiency to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
- Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm.
- Willing and able to travel 80-90% of their time in the Northern Bluegrass region of KY for face-to-face member visits.
- Valid KY driver's license, proof of vehicle insurance, and reliable transportation.
- Reside in or adjacent to the assigned Northern Bluegrass region: Boone, Bourbon, Campbell, Carroll, Gallatin, Grant, Harrison, Kenton, Nichols, Owen, Pendleton, or Scott.
- Case Management in an integrated model.
- Bilingual.
- Associate's degree in Nursing required.
- BSN preferred.
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