Case Manager, Registered Nurse
CVS Health
Case Manager – Registered Nurse
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States • New York, Ohio
Visit company websiteSalary
💰 $54,095 - $116,760 per year
Job Level
Mid-LevelSenior
About the role
- Use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individual and family comprehensive health needs
- Act as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel
- Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care
- Interact with members/clients telephonically or in person; may meet members in homes, worksites, or physician’s offices
- Assess and analyze injured, acute, or chronically ill members/clients medical and/or vocational status; develop a plan of care to optimize wellness, medical outcomes, and return to work or optimal functioning
- Communicate with stakeholders (medical providers, attorneys, employers, insurance carriers) and prepare required documentation of case work activities
- Consult with internal multidisciplinary team to maximize best health outcomes and outreach to treating physicians or specialists as appropriate
- Provide educational and prevention information for best medical outcomes and apply relevant laws, regulations, and insurance instructions
- Conduct evaluations of needs and benefit plan eligibility and facilitate integrative functions using clinical tools and data
- Monitor member/client progress toward desired outcomes through assessment and evaluation
- Facilitate appropriate condition management, optimize overall wellness, and develop proactive courses of action to enhance short- and long-term outcomes
Requirements
- 3+ years clinical practical experience (preference: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
- 2+ years case management, discharge planning and/or home health care coordination experience
- Active and unrestricted Compact Registered Nurse (RN) License
- Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
- Bachelor's Degree in Nursing (PREFERRED)
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills
- Ability to work independently (may require working from home)
- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, and proprietary applications
- Efficient computer skills including navigating multiple systems and keyboarding
- Willing and able to obtain single state Registered Nurse (RN) licenses if needed (company will provide Certified Case Manager)
- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) (preferred)
- Anticipated Weekly Hours: 40
