Case Manager, Registered Nurse (Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania)

The Muse; Gettysburg (Adams County); On-site; USD 60,000 - 130,000; Full time

Job summary

Join a leading health solutions company as a Case Manager, Registered Nurse. In this role, you will provide critical patient care and community-based management services across various counties, ensuring comprehensive health strategies and support for members. Applicants should possess an active RN license in Pennsylvania and relevant experience in nursing or case management.

Benefits

Affordable medical plan options

401(k) plan with company matching

Employee stock purchase plan

Wellness programs

Flexible work schedules

Tuition assistance

Qualifications

• Active and unrestricted Pennsylvania RN licensure required.
• 3 years of clinical experience preferred in relevant fields.
• 2 years of case management experience required.

Responsibilities

• Assesses needs and develops member care plans.
• Coordinates with healthcare providers and community resources.
• Maintains documentation of case management activities.

Skills

Analytical skills

Problem-solving skills

Communication skills

Education

Bachelor's of Science Degree in Nursing

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

Case Manager, Registered Nurse (Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania)

Join to apply for the Case Manager, Registered Nurse (Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania) role at The Muse

Case Manager, Registered Nurse (Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania)

16 hours ago Be among the first 25 applicants

Join to apply for the Case Manager, Registered Nurse (Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania) role at The Muse

At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Schedule: Monday through Friday 8:00 AM - 5:00 PM Eastern Standard Time (EST)

Travel: Up to 10-25% travel in Adams, Berks, Chester, Dauphin, or Franklin Counties, PennsylvaniaHelp us elevate 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 social 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 healthcare 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 overall 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 outcomes.

Additional responsibilities to include but not limited to the following:- Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.

• Implements and coordinates all 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 levels 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 provide 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 appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
• Testifies as required to substantiate any relevant case work or reports.
• 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 outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• 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/client's overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications - Active and unrestricted Pennsylvania Registered Nurse (RN) licensure
• 3 years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
• 2 years Case Management, Discharge Panning, and/or Home Health Care Coordination experience
• Must be willing to travel 10-25% within Adams, Berks, Chester, Dauphin, or Franklin Counties, Pennsylvania Preferred Qualifications - Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently (may require working from home).
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
• Efficient and Effective computer skills including navigating multiple systems and keyboarding
• Certified Case Manager is preferred.
• Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required
• Bachelor's of Science Degree in Nursing Education Associates degree or Nursing Diploma Required Anticipated Weekly Hours
  
  

40Time Type

Full timePay Range

The typical pay range for this role is:$60,522.80 - $129,615.20This 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.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 peopleWe 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 all 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 access and many other benefits depending on eligibility.
  
  

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Technology, Information and Internet

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