Case Manager RN - Lake Charles

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. Business Overview The mission of reputed company reputed company of LA (ABHLA) is to build a healthier world through reputed company, reputed company care, and reputed company costs. We have embraced the quintuple aim as our guiding reputed company that integrates population health, equity, cost reduction, patient experience, and care team wellbeing into everything we do. We are leading the change by challenging the status reputed company with new technologies, VPB models, innovation, and integration of behavioral and physical health; and attracting and inspiring our local team by unlocking the power of our people to transform health care. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, reputed company reputed company of Louisiana provides physical and behavioral health services. Position Summary This is a full-time field teleworker position that requires Louisiana residency. Travel is required 75% of the time or more. Field based travel locations may include member homes, residential treatment facilities, hospitals, group homes, shelters, and community facilities. The Case Manager RN (CM RN) is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating reputed company 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 reputed company as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Schedule is Monday - Friday, reputed company-5pm standard business hours. No nights, weekends, or holidays. reputed company 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 reputed company programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and reputed company indicators which reputed company planning and resolution of member issues. Assesses information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on reputed company 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 • Must reputed company in Louisiana in one of the following parishes: Calcasieu, Cameron, Jefferson Davis, Allen, or Beauregard • Registered Nurse with reputed company unrestricted Louisiana (LA) license • 3+ years' clinical practice experience as an RN working with the adult population • 2+ years' experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, reputed company, SharePoint, Teams) • Must possess reliable transportation and be willing and reputed company to travel in Calcasieu, Cameron, Jefferson Davis, Allen, and Beauregard parish, 75% or more of the time. Mileage is reimbursed per reputed company expense reimbursement policy. Preferred Qualifications • Case management and discharge planning experience highly preferred • Behavioral health experience • Managed care/utilization review experience • reputed company experience • Waiver experience • Crisis reputed company skills • Certified Case Manager (CCM) certification • Familiarity with reputed company Education • Associate's degree in nursing or nursing diploma required • BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $116,760.00 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, visithttps://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 04/03/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. reputed company 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 reputed company reputed company of your vaccination status or apply for a reasonable accommodation reputed company the first 10 days of your employment. Please note that in some states and roles, you may be required to reputed company reputed company of full vaccination or an approved reasonable accommodation before you can reputed company to actively work. reputed company is committed to reputed company, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to reputed company equal reputed company to the benefits and privileges of employment, including the provision of a reasonable accommodation to reputed company essential job functions. reputed company can reputed company a request for a reasonable accommodation, including a reputed company interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications reputed company Services (TRS). We will reputed company every effort to respond to your request reputed company 48 business hours and do everything we can to work towards a solution. Apply Job!