Case Manager, Registered Nurse – Medicare Advantage
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Illinois • United States
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Salary
💰 $66,575 - $142,576 per year
About the role
- Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
- Interacts with members/clients telephonically or in person
- May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services
- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
- Prepares all required documentation of case work activities as appropriate
- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate
- Provides educational and prevention information for best medical outcomes
- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources
- Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data
- Utilizes case management processes in compliance with regulatory and company policies and procedures
- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work
- 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/client’s overall wellness through integration
- Monitors member/client progress toward desired outcomes through assessment and evaluation
Requirements
- Registered Nurse with active state license in Illinois
- Minimum 3+ years of clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
- Minimum 2+ years of case management, discharge planning, and/or home health care coordination experience
- Bilingual preferred
- Certified Case Manager is preferred
- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required
- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
- Efficient and Effective computer skills including navigating multiple systems and keyboarding
- Willing and able to obtain multi state RN licenses if needed
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementdischarge planninghome health care coordinationclinical assessmentvocational assessmentcondition managementwellness optimizationdocumentation preparationevaluationoutreach
Soft Skills
communicationinterpersonal skillsorganizational skillsteam collaborationproblem-solvingproactive planningeducational skillsanalytical skillsclient advocacymultilingual
Certifications
Registered NurseCertified Case ManagerCRCCDMSCRRNCOHNCCM