Case Manager Registered Nurse - Field - reside

Overview

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.

Nurse Case Manager is responsible for face to face and telephonically 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. 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.

Services strategies policies and programs are comprised of network management and clinical coverage policies.

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.

Productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer-generated documents. Work requires sitting for extended periods, talking on the telephone, travel to member’s homes and typing on the computer.

Monday-Friday Standard Business Hours.

• RN with current unrestricted Virginia state licensure required
• 3+ years clinical experience as a Registered Nurse (i.e. med surg, behavioral health, acute care)
• Must reside in Alexandria, Arlington, Annandale Virginia or Surrounding Areas
• Must be willing and able to travel up to 75% of the time to meet members in their home

• Case Management in an integrated model preferred
• Bilingual in English/Spanish preferred
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

• Associate degree in Nursing required
• Bachelor’s degree preferred
• Unrestricted Virginia State RN License required.

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.

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