[Hiring] Case Manager - Registered Nurse @CVS Health

Role Description

Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs.

Fundamental Components & Physical Requirements

• Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care.
• Interacts with members/clients telephonically or in person, including home visits.
• Assesses and analyzes injured, acute, or chronically ill members/clients' medical and/or vocational status.
• Communicates with member/client and other stakeholders as appropriate.
• Prepares all required documentation of case work activities.
• Interacts and consults with internal multidisciplinary team as indicated.
• May make outreach to treating physician or specialists concerning course of care and treatment.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services.
• Testifies as required to substantiate any relevant case work or reports.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility.
• Utilizes case management processes in compliance with regulatory and company policies.
• Facilitates appropriate condition management and optimizes overall wellness and medical outcomes.
• Develops a proactive course of action to address issues presented.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

Qualifications

• Candidate must reside in Florida.
• Candidate must have active and unrestricted Compact Registered Nurse (RN) License in Florida.
• 3+ years clinical practical experience (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
• 2+ years case management, discharge planning and/or home health care coordination experience.

Preferred Qualifications

• Ability to occasionally travel within a designated geographic area for in-person case management activities.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently (may require working from home).
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.
• Certified Case Manager.
• Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM).

Education

• Associate's Degree in Nursing with equivalent experience or Nursing Diploma (REQUIRED).
• Bachelor's Degree (PREFERRED).

License

• Active and unrestricted Compact Registered Nurse (RN) License in Florida.

Work from Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer.
• Minimum download speed of 25 mbps and 3 mbps upload.
• A quiet, secure and private designated home virtual work location.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• Commitment to obtaining required internet speeds and adherence to all Work From Home requirements.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
• Ability to log in to secure systems, manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently.
• Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $60,522.00 - $129,615.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.

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.