What are the responsibilities and job description for the Case Manager RN position at 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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Position Summary
Candidate must be willing and able to travel 50-80% of the time and be located in Manassas, Chantilly or surrounding areas. Travel time can be up to an hour (60 miles) each way. Travel will include visiting member home and going into the Chantilly office for meetings.
Nurse Case Manager 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. Services strategies policies and programs are
comprised of network management and clinical coverage policies.
Through the use of 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.
Assessments take into account 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. Assessments include the member’s level of
work capacity and related restrictions/limitations. 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.
Required Qualifications
-Current and unrestricted Virginia state licensure
-Must be located in Chantilly, Manassas, or surrounding areas and willing to travel 50-80% of the time
-2 years of clinical practice experience as an RN
Preferred Qualifications
Case Management in an integrated model preferred
Bilingual preferred
5 years clinical practice experience
Education
RN with current unrestricted state licensure required.