[Hiring] Case Manager RN - Registered Nurse Maternity/Fertility @CVS Health

Role Description

This position is for a Fertility Advocate- high-risk maternity case management team and experience with this is required.

• The Case Manager RN is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members.
• Evaluate the medical needs of the member to facilitate the member’s overall wellness within a high-risk maternity case management program.
• Develop a proactive course of action to address issues presented to enhance short and long-term outcomes.
• Conduct evaluations of member's needs and benefit plan eligibility using clinical tools and information/data review.
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers.
• Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses.
• Review prior claims to address potential impact on current case management and eligibility.
• Utilize a holistic approach to assess the need for referrals to clinical resources.
• Consult with supervisor and others to overcome barriers in meeting goals and objectives.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Ensure maximum member engagement through effective interviewing skills.

Qualifications

• Must have active, current and unrestricted RN License in state of residence.
• Applicants must be willing and able to pursue multi-state licensure (paid for by the company).
• 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, Infertility, maternity and/or OB-GYN office setting.

Requirements

• Preferred RN licensure in a compact state.
• 1+ years of Case Management experience in an integrated model.
• 1+ years of experience with Telephonic Case Management.
• Certified Case Manager (CCM) certification.

Education

• Associates Degree in Nursing required.
• BSN preferred.

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.