Bring 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.
Schedule:
Monday-Friday 8AM - 5PM Central
Travel:
Up to 55-75% travel expected in Houston, TX and surrounding areas.
Position Summary
Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs.
Family Summary/Mission
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Position Summary/Mission
Community Care Case Manager use 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 through communication and available resources to promote quality, cost effective outcomes.
Fundamental Components & Physical Requirements
• 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.
• Interacts with members/clients telephonically or in person, may be required to meet with them in their homes, worksites, or physician’s office.
• 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.
• Interacts and consults with internal multidisciplinary team as indicated.
• 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.
• Testifies as required to substantiate any relevant case work or reports.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.
Required Qualifications
• Active and good standing Texas Compact RN license.
• Minimum 5+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac with Medicare members)
• Minimum 2+ years Case Management, discharge planning and/or home health care coordination experience.
• Willing and able to travel up to 55-75% of their time to meet members face to face in Houston, TX and surrounding areas.
• Reliable transportation is required; Mileage is reimbursable as per company policy.
Preferred Qualifications
• 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.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.
• Willing and able to obtain multi-state RN licenses if needed; company will provide.
• Bachelor’s degree preferred.
• Certified Case Manager is preferred.
Education
• Associates degree minimum required; applicant may be required to obtain a bachelor’s degree within 3+ years as part of role development.
Pay Range
The typical pay range for this role is: $60,522.80 - $129,615.20. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
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.
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