CVS Health Case Manager RN in Helena, Montana
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.
Position Summary
This is a remote work from home role anywhere in the US with virtual training.
Shift schedule is 8:30am - 5pm within time zone of residence.
This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
Identifies and escalates member’s needs appropriately following set guidelines and protocols.
Need to actively reach out to members to collaborate/guide their care.
Perform medical necessity reviews.
Required Qualifications
5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting.
A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive multi-state/compact privileges and can be licensed in all non-compact states.
1+ years’ experience documenting electronically using a keyboard.
1+ years’ current or previous experience in Oncology, Behavioral Health/Substance Abuse, Maternity, Maternal Newborn, Transplant, Pediatric, Medical/Surgical, or Specialty Pharmacy.
Preferred Qualifications
1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care.
1+ years' experience in Utilization Review.
CCM and/or other URAC recognized accreditation preferred.
1+ years’ experience with MCG, NCCN and/or Lexicomp.
Education
Diploma or Associates Degree in Nursing required.
BSN preferred.
Pay Range
The typical pay range for this role is:
$54,095.60 - $116,760.80
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.
For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 10/25/2024.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action 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.
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