Case Manager RN

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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

Aetna Better Health of Kansas is committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day.

We are looking for talent like you who value excellence, integrity, caring and innovation. As an employee, you'll join a team dedicated to improving the lives of Aetna Better Health of Kansas members.

We value diversity and are dedicated to helping you achieve your career goals.

This will be a full-time telework role in Kansas, however, will require 50-75% travel for face to face visits.

Schedule is Monday-Friday, standard business hours.

Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.

Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members :

• Through the use of care management tools and information / data review, conducts comprehensive evaluation of referred member's needs / eligibility and recommends an approach to case resolution and / or meeting needs by evaluating member's benefit plan and available internal and external programs / services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate
• Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care :

Using holistic approach consults with case managers, supervisors, Medical Directors and / or other health programs to overcome barriers to meeting goals and objectives;

presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes .

• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and / or healthcare needs.
• Utilizes influencing / motivational interviewing skills to ensure maximum member engagement and promote lifestyle / behavior changes to achieve optimum level of health.
• 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.

Monitoring, Evaluation and Documentation of Care :

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Required Qualifications :

• 3+ year of clinical experience required
• Active and good standing RN license for Kansas
• Willing and able to travel up to 50-75% of their time to meet members face to face in Sedgwick County and surrounding areas / counties.
• Reliable transportation is required and mileage reimbursement is eligible based on company policy.

Preferred Qualifications :

• Computer literacy and demonstrated proficiency is required in order to navigate through internal / external computer systems, and MS Office Suite applications, including Word and Excel is strongly preferred.
• Case management and discharge planning experience preferred
• Managed Care experience preferred
• 1-year Experience in Home and Community based services (HCBS) waiver.

Education :

• Associates degree in nursing required
• BSN 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.