Case Manager – Registered Nurse, Compact RN License Required
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Alabama • Arizona • United States
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Salary
💰 $60,522 - $129,615 per year
About the role
- 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
- Developing 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
- Conducting an evaluation of member’s needs and benefit plan eligibility and facilitating integrative functions as well as smooth transition to Aetna programs and plans
- Applying 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
- Reviewing prior claims to address potential impact on current case management and eligibility
- Assessing the member’s level of work capacity and related restrictions/limitations
- Consulting 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
Requirements
- Candidate must have an active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence
- 5 years clinical practice experience as an Registered Nurse (RN)
- 2+ years’ experience in critical care
- 6+ months case management or utilization management experience
- Must be able to work Monday - Friday 8 AM to 5 PM in the time zone of residence (There are currently no nights, weekends, and holidays; however, is subject to change based on business needs)
- Must be able to obtain multi state Registered Nurse (RN) licensures
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementclinical judgmentcritical careutilization managementmedical needs assessmentcare planningrisk factor reductionbenefit plan eligibility evaluationmember wellness enhancementmultidisciplinary collaboration
Soft Skills
communicationproblem-solvingorganizational skillsteam collaborationgoal orientationadaptabilityinterpersonal skillsconsultationpresentation skillsstrategic planning
Certifications
Registered Nurse (RN) licensurecompact RN licensure