About the position
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Case Manager RN role is telework and must Live in North Carolina. Normal Working Hours: Monday through Friday 9:00am - 5:30pm EST. Occasional evening, weekend, and holiday shifts per the needs of the team. 0-10% travel possible including but not limited to travel to the High Point office for customer meetings. The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
Responsibilities
- 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 overall wellness through integration.
- Conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
- Applies 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.
- Assesses information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assesses the member's level of work capacity and related restrictions/limitations.
- Uses a holistic approach to assess the need for a referral to clinical resources for assistance in determining 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.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Requirements
- Must have an active and unrestricted RN license in the state of North Carolina.
- Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company).
- 2+ years of clinical experience as an RN.
- All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.
Nice-to-haves
- Certified Case Manager (CCM) certification.
- 3+ years' experience with Microsoft Office Suite.
- Case Management in an integrated model.
- Discharge Planning experience.
- Managed care experience.
- BSN.
Benefits
- Affordable medical plan options.
- 401(k) plan (including matching company contributions).
- Employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
