[Hiring] Case Manager, Registered Nurse Field @CVS Health

Role Description

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. 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.

Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for:

• Assessing, planning, implementing, and coordinating all case management activities with members.
• Evaluating the medical needs of the member to facilitate the member’s overall wellness.

Fundamental Components & Physical Requirements:

• Develops a proactive plan of care to address identified issues to enhance short and long-term outcomes.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers.
• Conducts assessments considering information from various sources, such as claims.
• Uses a holistic approach to assess the need for referrals to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement.
• Interacts with members/clients telephonically or in person, possibly in their homes, worksites, or physician’s office.

Qualifications

• Must reside in the state of Illinois.
• Must possess reliable transportation and be willing and able to travel up to 75% of the time from home location.
• Minimum 3-5 years clinical practical experience.
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Effective computer skills including navigating multiple systems and keyboarding.
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint.

Requirements

• 2-3 years Care Management, discharge planning and/or home health care coordination experience (preferred).
• Certified Case Manager (preferred).
• Bilingual (preferred).

Education

• Associate's degree required.
• Active and unencumbered Registered Nurse license in the state of Illinois required.

Benefits

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