Onsite Sr Clinical Consultant, RN -Gwinnett County (Lawrenceville, GA) BoC
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.
The Onsite Sr Clinical Consultant, RN collaborates with Gwinnett County Board of Commissioners’ onsite Employee Wellness Center, HR Benefits team and Aetna’s Aetna One Advisor (A1A) team to establish and implement efficient and effective delivery of healthcare services. Serves as an extension of the A1A team by assisting in the management of coordinating patient care, implementing quality improvement initiatives, and maintaining regulatory compliance. Collaborates with interdisciplinary teams and contributes to enhancing patient outcomes and overall operational excellence.
The Onsite Sr Clinical Consultant, RN role is a full-time, client-based position working onsite at Gwinnett County Board of Commissioners. Work schedule aligns with the Gwinnett Employee Wellness Center hours of operation. Must be flexible to modify work schedule to start earlier or work later with potential evening and weekend hours for special events with advanced notice. Hours may change depending on business strategy.
Limited travel of up to 25% to meet with members at various worksites across Gwinnett County.
What you will do:
- Utilizes clinical skills and experience to coordinate, document, and communicate essential aspects of the A1A and benefits management program.
- Utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote/influence members in decisions related to achieving and maintaining optimal health status.
- Conducts proactive outreach based on the needs of the population, wellness and prevention for age-appropriate health screenings, cost-effective choices and health plan benefits.
- Consults and lends Clinical expertise to key internal and external constituents in the coordination and administration of benefits management initiatives and objectives.
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services and benefits for members.
- Works closely with the A1A team, and onsite Employee Wellness Center vendor to enhance the member experience.
- Responds to inquiries on benefit plan structure, member cost share for medical and pharmacy services, claims review, prior authorization and connects members to the right resources to address all health care needs.
- Leverages the information available to assist in member education, identification of organization specific values, mission, vision and goals for holistic wellbeing.
- Promotes and attends health screenings. Provides general health and preventive screening education and resources at employer worksites as well as track and trend data.
- Confers internally and externally with clients and senior management regarding the organization's goals and objectives.
- Collaborates with the Gwinnet Team to initiate programs identified by the top clinical conditions (diabetes, obesity, hypertension, muscular skeletal, etc.). Evaluate utilization patterns based on client specific data to form recommendations on future solutions.
- Attends and consults during utilization meetings.
- Collaborates with the Plan Sponsors wellness team on activities for monthly health observance (i.e. breast cancer, men’s health awareness).
- Partners with Public and Labor Account Management team to optimize customer satisfaction and retention.
Required Qualifications:
- A Registered Nurse that must hold an unrestricted license in Georgia, with multi-state/compact privileges and be willing and able to be licensed in all non-compact states, as needed where membership resides.
- 3+ years of clinical practice experience required as an RN.
- There is a requirement to live within a commutable distance of plan sponsor’s onsite Employee Wellness Center located in Lawrenceville, GA (typically within 45 minutes maximum).
Preferred Qualifications:
- Case Management in an integrated model working with employer programs.
- Certified Case Manager (CCM) certification.
- Advanced problem solving and decision-making skills.
- Advanced knowledge of medical terminology.
- Advanced collaboration and teamwork skills.
Education:
- Bachelor of Science in Nursing required and Masters preferred.
Pay Range:
The typical pay range for this role is: $60,300.00 - $173,040.00. 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.
We anticipate the application window for this opening will close on: 10/30/2024.
#J-18808-Ljbffr
