Case Manager RN- Field

CVS Health

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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.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

This is a telework position with 50% travel to meet members face to face. opportunity in Kansas

Qualified candidates must reside within the Johnson, Wyandotte, Miami county or surrounding areas.

Responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination / collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

• Responsible for telephonically and / or face to face assessing, planning, implementing and coordinating all care management activities with members to evaluate the medical and behavioral health needs 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.
• Through the use of clinical tools and information / data review, conducts comprehensive assessments of member's needs / eligibility and determines approach to case resolution and / or meeting needs by evaluating member's benefit plan and available internal and external programs / services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex health and social indicators which impact care planning and resolution of member issues.
• Completes assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and include the member's restrictions / limitations.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment / services.
• Applies and interprets 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.
• Using holistic approach consults with manager, Medical Directors and / or other physical / behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
• Presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• Works collaboratively with the members' interdisciplinary care team.
• Identifies and escalates quality of care issues through established channels.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing / motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Provides coaching, information and support to empower the member to make ongoing independent medical and / or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• In collaboration with the member and their care team develops and monitors established plan of care to meet the member's goals.
• Utilizes care management processes in compliance with regulatory and company policies and procedures.
• Facilitates clinical hand offs during transitions of care.

Required Qualifications

• Active and unrestricted RN license in the state of KS.
• 2+ years of clinical practice experience (e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic / facility)
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, as need basis.
• 2+ years demonstrated experience with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
• Willing and able to travel 50% of their time to meet members face to face Johnson, Wyandotte, Miami county County KS and surrounding areas / counties.
• Reliable transportation required; Mileage is reimbursable as per company policy.

Preferred Qualifications

• 2+ Managed care / utilization review experience
• Case management in an integrated model
• Discharge planning experience
• HCBS Waiver Experience
• Bilingual in Spanish.

Education

• Minimum of Associate's degree or diploma nursing degree required
• BSN degree preferred

Pay Range

The typical pay range for this role is :

$60,522.80 - $129,600.00

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.

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 jobs.CVSHealth.com / benefits

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.