[Hiring] Case Manager, Registered Nurse @CVS Health

Role Description

Help us elevate our patient care to a whole new level! Join our 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 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. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

As a case manager, you will coordinate and facilitate comprehensive care for individuals by:

• Assessing their needs
• Developing personalized care plans
• Coordinating services across healthcare providers

Additional responsibilities include but are not limited to:

• Acting as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implementing and coordinating all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care.
• Interacting with members/clients telephonically or in person.
• Assessing and analyzing injured, acute, or chronically ill members/clients medical and/or vocational status.
• Communicating with member/client and other stakeholders as appropriate.
• Preparing all required documentation of case work activities.
• Interacting and consulting with internal multidisciplinary team as indicated.
• Making outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Providing educational and prevention information for best medical outcomes.
• Applying all laws and regulations that apply to the provision of rehabilitation services.
• Conducting an evaluation of members/clients’ needs and benefit plan eligibility.
• Utilizing case management processes in compliance with regulatory and company policies and procedures.
• Facilitating appropriate condition management and optimizing overall wellness.
• Developing a proactive course of action to address issues presented.
• Monitoring member/client progress toward desired outcomes through assessment and evaluation.

Qualifications

• Active and unrestricted Compact Registered Nurse (RN) Licensure in their state of residence (PA, OH, FL, NJ, GA, NC, TX, CT).
• 3+ years of clinical practical experience (preference: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, Home Health) with Medicare members.
• 2+ years of case management, discharge planning and/or home health care coordination experience.
• Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint.
• Able to work in a fast-paced high-volume environment and utilize time management and prioritization skills.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.
• Working knowledge of problem solving and decision making skills.
• Working knowledge of medical terminology.
• Working knowledge of digital literacy skills.
• Ability to deal tactfully with customers and community.
• Ability to handle sensitive information ethically and responsibly.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.

Preferred Qualifications

• National professional certification (CRC, CDMS, CRRN, COHN, or CCM).
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Bilingual - Spanish.

Education

• Associate's Degree in Nursing (REQUIRED).
• Bachelor's Degree in Nursing (PREFERRED).

License

• Active and unrestricted Compact Registered Nurse (RN) Licensure in their state of residence (PA, OH, FL, NJ, GA, NC, TX, CT).

Work from Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer with a minimum download speed of 25 mbs download and 3 mbs upload.
• A quiet, secure and private designated home virtual work location, compliant with CVS Health and HIPAA guidelines.
• 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 adhering 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 via 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 (e.g., VPN, EHR portal) and manage strong passwords.
• 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: $54,095.00 - $142,576.00. 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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Additional details about available benefits are provided during the application process.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.