Case Manager, RN
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Job Description
Remote Case Manager RN coordinating assessments, care plans and discharge planning for CVS Health members. Advocating for quality, cost-effective healthcare outcomes.
Responsibilities:
- Assess members’ health status and care coordination needs
- Conduct inpatient review and discharge planning
- Develop, implement, monitor and evaluate case management plans
- Involve the Medical Director as indicated
- Close cases when members meet discharge criteria
- Use data-driven methods to identify members for individualized case management programs or alternative healthcare referrals
- Conduct comprehensive clinical assessments
- Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services
- Advocate for patients within existing healthcare coverage
- Promote quality, cost-effective outcomes and suggest program or operational efficiency improvements
- Identify and escalate quality-of-care issues through established channels
- Provide a high level of customer service
- Assess members’ health literacy, technology capabilities and readiness to change
- Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes
- Provide coaching, information, education and support to empower independent medical and healthy lifestyle choices
- Manage multiple priorities using organizational and time-management skills while collaborating effectively with the team
Requirements:
- Active, current and unrestricted RN license in state of residence
- Willingness and ability to obtain additional state licenses upon hire
- 3+ years of acute care experience as an RN
- Willingness and ability to work Monday through Friday, 8:00am through 4:30pm in time zone of residence, with an occasional late shift rotation of 11:00 AM–8:00 PM EST once per quarter
- Associate Degree required
- Compact RN License or multi-state licensure preferred
- Certified Case Manager (CCM) preferred
- Managed Care experience preferred
- Hospital experience in ICU, CCU, Step Down, ER or OR preferred
- Telephonic case management and/or telephonic experience preferred
- Direct/hardwired internet connection to a modem/router within 7 feet of computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
- Work within the state and city where currently living
- Provide own workspace furniture, such as a desk or standing desk
- Ability to set up and use multiple monitors and navigate multiple applications simultaneously
- Ability to communicate via email, calendar invites, Teams messaging and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace applications
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to maintain computer and password security and recognize suspicious emails or links
- Ability to resolve common technical issues independently and contact IT when needed
- Openness to learning new skills as the workplace evolves
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Additional state licenses paid for by the company
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