[Hiring] Care Manager - Registered Nurse @CVS Health

Role Description

This Case Manager RN position is 100% remote, allowing candidates to reside in any U.S. state. Positions are available across all time zones, with preference for Pacific Standard Time.

• Normal Working Hours: Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30am-7pm EST (1-2 times per quarter).
• Typical training hours are Monday-Friday 8-4:30 EST.
• Nurse Care Manager is responsible for telephonically and/or face to face 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.
• 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.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Conducts an evaluation of member's needs and benefit plan eligibility through the use of clinical tools and information/data review.
• 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.
• Assessments take into account 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.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach 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 MI skills to ensure maximum member engagement and discern their health status.

Qualifications

• Must have an active current and unrestricted Registered Nurse license in state of residence.
• 5+ years of acute care experience as an RN.
• Must be willing and able to work Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30AM to 7PM EST.
• Strong computer skills.
• Microsoft Suite familiarity.

Requirements

• Compact State licensure.
• CCM certification.
• Experience in care case management.
• Home Care experience.
• Spanish speaking/bilingual.
• Oncology experience/background.

Education

• Associate's with RN licensure, required; BSN, preferred.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.