Case Manager Registered Nursing (Field - Must reside in South Cook County Illinois)

Hispanic Alliance for Career Enhancement; Springfield (IL); On-site; USD 66,000 - 143,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to join their Long-Term Services and Supports team. This role is crucial for providing care coordination and support to members in South Cook County, Illinois. The ideal candidate will possess a strong clinical background and an Illinois RN license, with a commitment to improving healthcare outcomes for waiver members. You'll engage directly with members, utilizing your skills to empower them in their healthcare decisions. If you are passionate about making a difference in the lives of others, this is a fantastic opportunity to contribute meaningfully to the community.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Tuition assistance

Flexible work schedules

Qualifications

• 2+ years of clinical experience required.
• Active Illinois RN license is mandatory.
• Experience in case management preferred.

Responsibilities

• Facilitate healthcare outcomes for LTSS members.
• Conduct comprehensive evaluations of members' needs.
• Coordinate care plans and monitor progress.

Skills

Clinical Experience

Care Coordination

Healthcare Evaluation

Negotiation Skills

Motivational Interviewing

Education

Associates Degree

Bachelor of Science in Nursing

Tools

Microsoft Office

Job description

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

This Case Manager position is with Aetna's Long-Term Services and Supports (LTSS) team and is a field-based position out of South Cook County Illinois (specifically Cicero, Little Village, Stickney, Bridgeport, Englewood, Burbank, Chinatown, Pilsen, Canaryville, Back of the Yards, McKinley Park IL). The requirements is for candidates to hold an Illinois Registered Nursing license, and travel 50-75% of the time to meet with members face to face.

Typical work schedule is Monday- Friday 8am-5pm.

This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements.

Facilitate appropriate healthcare outcomes for waiver/LTSS 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 members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid 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 knowledgeably 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

- 2+ years of clinical experience

- Active and good standing Illinois RN license

- Must reside in South Cook County IL (specifically near Cicero, Little Village, Stickney, Bridgeport, Englewood, Burbank, Chinatown, Pilsen, Canaryville, Back of the Yards, McKinley Park IL)

- Must possess reliable transportation and be willing and able to travel 50-75% of the time to meet members face to face in Southern Cook County, and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

- Case Management and Discharge Planning experience preferred

- Managed Care experience preferred

- Microsoft Office experience preferred

Education:

- Associates Degree Required

- Bachelor's of Science & Nursing Preferred

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$66,575.00 - $142,576.00

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.

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 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/benefits

We anticipate the application window for this opening will close on: 05/29/2025

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

CVS Health 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 provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [e-mail] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.