Case Manager RN - West Region WV

CVS Health • Charleston, WV, United States • $200k - $250k / year • 3w ago

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Business Overview

The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia’s Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state.

Position Summary
This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Western region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in the region, in one of the following counties: Wood, Wirt, Jackson, Mason, Putnam, Cabell, Lincoln, Wayne.

Schedule is Monday – Friday, 8am - 5pm, standard business hours. No nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.

The Case Manager RN (CM RN) is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.

Fundamental Components

Conducts face to face member visits
Using clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
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.
Assesses information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Reviews prior claims to address potential impact on current case management and eligibility.
Using a holistic approach assess the need for a referral to clinical resources for assistance in determining 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.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

Required Qualifications

Registered Nurse with current unrestricted West Virginia (WV) license or Registered Nurse with current unrestricted WV "multi-state privilege” license
3+ years’ clinical practice experience
2+ years’ experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Must possess reliable transportation and be willing and able to travel in the West Region of WV 50% or more, of the time. Mileage is reimbursed per our company expense reimbursement policy
Qualified candidates must reside in the West region, in one of the following counties: Wood, Wirt, Jackson, Mason, Putnam, Cabell, Lincoln, Wayne

Preferred Qualifications

Pediatric experience
Medicaid experience
Waiver experience
Foster care experience
Crisis intervention skills
Managed care/utilization review experience
Certified Case Manager (CCM) certification
Case management experience in an integrated model
Case management and discharge planning experience
Familiarity with QuickBase

Education

Associate’s or Diploma in Nursing required
BSN degree 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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

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 prevents 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.

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