Case Manager Registered Nurse

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

Location:

This role will be work at home with less than 5% travel that may be required in the event of clinical audits.

Schedule:

Monday-Friday 8:00am-4:30pm in the time zone of residence with occasional late shift rotation until 9:00pm. Employees can flex their 8-hour shift between 8:00am-6:00pm. There are no weekends or holiday shifts required at this time.

The Case Manager RN is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. This Case Manager RN role is 100% remote, and the employee can live in any state and telework, however, there is a preference for an RN in a Compact RN state.

Key Responsibilities Develops 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, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

Applies 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 take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

Reviews prior claims to address potential impact on current case management and eligibility.

Assessments include the member's level of work capacity and related restrictions/limitations.

Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

Utilizes case management processes in compliance with regulatory and company policies and procedures.

Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Remote Work Expectations This is a 100% remote role, candidates must have a dedicated workspace free of interruptions.

Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications Must reside in MST, PST, or CST.Must have an active current and unrestricted RN license in state of residence.

Willingness and ability to obtain additional state licenses upon hire (paid for by the company).3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ICU experience).

Preferred Qualifications 1+ years of case management and/or Home Health experience.

Compact RN licensure.

Certified Case Manager (CCM) certification.

Experience with all types of Microsoft Office including PowerPoint, Excel, and Word.

Strong telephonic communication skills.

Education Associate's Degree in Nursing required.

Bachelor's of Science and Nursing preferred.

Anticipated Weekly Hours
40

Time Type Full time

Pay Range 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.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness…