Job Requisition ID: R0402345
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.
Position Summary
The Case Manager RN position is 100% remote and employees can live in any state.
Normal Working Hours: Monday through Friday 9:00am - 5:30pm. There is a late shift requirement once a quarter from 12:30-9:00pm. Weekends are not required. Holidays are covered on a volunteer basis. There is no travel expected with this position.
This Case Manager RN position is part of Aetna's Commercial Care Management division.
The RN's 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 overall wellness.
- Develop a proactive course of action to address issues presented to enhance short and long-term outcomes and opportunities to enhance a member's overall wellness through integration.
- Conduct evaluations of member's needs and benefit plan eligibility through clinical tools and information/data review, facilitating smooth transitions to Aetna's programs and plans.
- Apply clinical judgement to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning and resolution of member issues.
- Assessments take into account information from various sources to address all conditions including co-morbidities and multiple diagnoses that impact functionality.
- Review prior claims to address potential impacts on current case management and eligibility.
- Assess member's level of work capacity and related restrictions/limitations.
- Using a holistic approach, assess the need for referrals to clinical resources for assistance in determining functionality.
- Consult with supervisors and others to overcome barriers and meet goals and objectives, presenting cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Utilize interviewing skills to ensure maximum member engagement and discern their health status and needs based on key questions and conversations.
Required Qualifications
- Must have an active, current, and unrestricted RN licensure in the state of residence.
- Must be willing to obtain multiple state RN licensure after hire (expenses paid for by the company).
- 2+ years as an RN with med/surge experience, Emergency Department, and Telemetry.
- Must be willing to work Monday - Friday 9:00am - 5:30pm.
- Must be willing to work late shift once per quarter until 9pm.
- 1+ year experience with all types of Microsoft Office including PowerPoint, Excel, and Word.
Preferred Qualifications
- 2+ years of Case Management experience.
- Strong telephonic communication skills.
- Certified Case Manager (CCM) certification.
Education
Associates degree in Nursing; BSN preferred.
Pay Range
The typical pay range for this role is: $66,575.08 - $142,576.72.
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. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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