Case Manager Registered Nurse

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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate.

And we do it all with heart, each and every day.

The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and to help facilitate the member’s overall wellness.

Plan Sponsor business hours:
Monday through Friday 7:00am to 6:00pm CST. There are currently no nights, no weekends, and no holidays; however, it is subject to change based on business needs. You can choose your schedule between these hours with either a 30 or 60 min unpaid lunch.

• Develop 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.
• Through the use of clinical tools and information/data review, conduct an evaluation of member’s needs and benefit plan eligibility and facilitate integrative functions as well as smooth transition to programs and plans.
• Apply 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 consider information from various sources to address all conditions including co‑morbid and multiple diagnoses that impact functionality.
• Review prior claims to address potential impact on current case management plan.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Use a holistic approach to assess the need for referral to clinical resources for assistance.
• Consult with supervisor and others in overcoming barriers in meeting goals and objectives; present cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Utilize interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Must have an active, current and unrestricted RN licensure in the state of residence and be willing to apply for a Compact RN (fees paid by company).

5 years clinical practice experience as an RN.

Must be able to work Monday through Friday between the hours of 7:00am to 6:00pm CST. There are currently no nights, no weekends, and no holidays; however, it is subject to change based on business needs.

6+ months Case Management or Utilization Management experience.

Case Management Certification.

Associate Degree required.

BSN preferred.

40

Full time

The Typical Pay Range For This Role Is $60,522.00 - $. 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.

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.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for…