Case Manager
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Job Description
RN Case Manager assessing and coordinating members’ medical needs for CVS Health. Developing care plans and connecting members with appropriate health resources.
Responsibilities:
- Assess, plan, implement, and coordinate case management activities telephonically and/or face to face
- Evaluate members’ medical needs to facilitate overall wellness
- Develop proactive courses of action to enhance short- and long-term outcomes
- Evaluate member needs and benefit plan eligibility using clinical tools and information/data review
- Facilitate integrative functions and transitions to Aetna programs and plans
- Apply clinical judgment to reduce risk factors and address complex health and social indicators
- Assess co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions or limitations
- Review prior claims and assess the need for clinical resource referrals
- Consult with supervisors and participate in multidisciplinary case conferences
- Use case management processes in compliance with regulatory and company policies
- Conduct interviews to engage members and determine health status and needs
Requirements:
- Registered Nurse with active and unrestricted RN licensure in their state of residence
- Preferably multi-state/compact privileges
- Must have the ability to be licensed in all non-compact states
- 3+ years clinical practice experience required
- Associate's degree required
- Compact RN licensure preferred
- Case management experience preferred
- Case Manager Certification preferred
- Experience with Windows / Microsoft Office preferred
- Strong computer skills preferred
- Bilingual (English/Spanish) speaking preferred
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay
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