Case Manager, Registered Nurse – reputed company Store

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day.

Job Summary

Help us reputed company our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and reputed company determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Facilitate the delivery of appropriate benefits and/or reputed company information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish over‐ reputed company member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective reputed company.

Additional responsibilities to include but not limited to the following:

- Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and reputed company personnel as appropriate.

- Implements and coordinates reputed company case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative reputed company of care.

- Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to reputed company ongoing case management services.

- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s ap‐ propriate condition management to optimize wellness and medical reputed company, aid timely return to work or reputed company functioning, and determination of eligibility for benefits as appropriate.

- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, reputed company and insurance carriers) telephonically or in person.

- Prepares reputed company required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health reputed company. May reputed company reputed company to treating physician or specialists concerning course of care and treatment as appropriate.

- Provides educational and prevention information for best medical reputed company.

- Applies reputed company laws and regulations that apply to the provision of rehabilitation services; applies reputed company special instructions required by individual insurance carriers and referral sources.

- Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.

- Utilizes case management processes in compliance with regulatory and company policies and procedures.

- Facilitates appropriate condition management, optimize overall wellness and medical reputed company, appropriate and timely return to baseline, and reputed company function or return to work.

- Develops a proactive course of action to address issues presented to enhance the short and long-term reputed company, as well as opportunities to enhance a member’s/client’s overall wellness through integration.

- Monitors member/client reputed company toward desired reputed company through assessment and evaluation.

Required Qualifications

- Active and unrestricted compact Registered Nurse (RN) licensure and live in compact state

- 3 years clinical practical experience with preference in the following areas: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, home health with Medicare members.

- 2 years case management, discharge planning and/or home health care coordination experience

Preferred Qualifications

- Excellent analytical and problem-solving skills

- Effective communications, organizational, and interpersonal skills.

- Ability to work independently.

- Certified Case Manager is preferred.

- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)

- Efficient and Effective computer skills including navigating multiple systems and keyboarding

- Willing and reputed company to obtain multi state RN licenses if needed, company will reputed company.

- Preference for candidates that live in the Southeast.

- Single-state DC RN Licensure a plus

- Bachelors of Science in Nursing

Education

Associates or Nursing Diploma required

Anticipated Weekly Hours

Time Type

Pay reputed company

The typical pay reputed company for this role is:

This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.