Job Description
This is a telework role open to candidates located in Hamilton County, Ohio. This role will require 50-75% travel in Hamilton County.
Working schedule: Monday-Friday, 8am-5pm.
My Care of Ohio is hiring for care management in one of our counties we serve.
We are seeking self-motivated, energetic, detail-oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members. The Nurse Case Manager is responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating all case management activities with members to evaluate their medical needs and facilitate their overall wellness.
Responsibilities:
- Develop a proactive course of action to address issues presented to enhance short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
- Utilize clinical tools and information/data review to conduct evaluations of member needs and benefit plan eligibility, facilitating integrative functions and smooth transitions to Aetna programs and plans.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers, addressing complex health and social indicators impacting care planning and resolution of member issues.
- Conduct assessments that consider information from various sources to address all conditions, including co-morbid and multiple diagnoses that impact functionality.
- Review prior claims to assess potential impacts on current case management and eligibility.
- Assess members' level of work capacity and related restrictions/limitations.
- Using a holistic approach, assess the need for referrals to clinical resources for assistance in functionality.
- Consult with supervisors and others to overcome barriers in meeting goals and objectives, presenting cases at case conferences for a multidisciplinary focus to benefit overall claim management.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Employ interviewing skills to ensure maximum member engagement and discern their health status and needs based on key questions and conversation.
Pay RangeThe typical pay range for this role is:
Minimum: 55,300
Maximum: 118,900
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will consider a wide range of factors, including location.
Required Qualifications- Active and unrestricted OH RN state licensure
- 3+ years of clinical experience
COVID RequirementsCOVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevent them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications- Home Health experience
- Computer Skills (Microsoft Office such as Word, Excel, and Outlook)
EducationAssociates Degree required.
Business OverviewBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CVS Health is an affirmative action employer and an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists, and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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