Case Manager, Registered Nurse

5 days ago

🐊 Florida – Remote

Although this job is listed in Florida, this company may be open to hiring remote in other states.

🌲 North Carolina – Remote

Although this job is listed in North Carolina, this company may be open to hiring remote in other states.

+1 more states

🐊 Florida – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote

💵 $54.1k - $116.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

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CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Community Care Case Manager (CM) uses a collaborative process of assessment • Planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs • Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care • Interacts with members/clients telephonically or in person • 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 • Communicates with member/client and other stakeholders as appropriate • Prepares all required documentation of case work activities as appropriate • Interacts and consults with internal multidisciplinary team to help member/client maximize best health outcomes • Provides educational and prevention information for best medical outcomes • Applies all laws and regulations that apply to the provision of rehabilitation services • Testifies as required to substantiate any relevant case work or reports • Conducts evaluation of members/clients’ needs and benefit plan eligibility • Utilizes case management processes in compliance with regulatory and company policies • Facilitates appropriate condition management, optimize overall wellness and medical outcomes • Develops proactive course of action to address issues presented to enhance outcomes • Monitors member/client progress toward desired outcomes

🎯 Requirements

• 3 years clinical practical experience: (Diabetes, CHF, CKD, Post-Acute Care, Hospice, Palliative Care, Cardiac) with Medicare members • Registered Nurse with active state license in good standing within the region where job duties are performed is required • Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise • 2 years CM, Discharge Planning, and/or Home Healthcare coordination experience 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, as well as some special proprietary applications • Efficient and Effective computer skills including navigating multiple systems and keyboarding • Compact RN licensure • Certified Case Manager • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) • Bachelors of Science in Nursing Education • Associates Degree in Nursing

🏖️ 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 • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access • Many other benefits depending on eligibility