Case Manager RN-Field

IntelliResume; Field (NM); On-site; USD 65,000 - 90,000; Full time

Job summary

CVS Health is seeking a Field-based Case Manager RN to assess, plan, implement and coordinate care for members in the community, combining telephonic and face-to-face visits. The role emphasizes clinical judgment to reduce risk factors and ensure appropriate benefit plan eligibility, with a strong focus on member engagement.

You will travel 50%+ in the western region, reside in West Virginia, and work full-time Monday–Friday 8am-5pm, conducting visits, reviewing claims, and collaborating with

Qualifications

• 5+ years of clinical practice experience.
• 2+ years of experience with personal computers and MS Office Suite.

Responsibilities

• Conduct face-to-face member visits.
• Evaluate member's needs and benefit plan eligibility using clinical tools.
• Apply clinical judgment to reduce risk factors and barriers.
• Assess information from various sources for co-morbid conditions.
• Review prior claims to impact current case management.
• Assess the need for referrals to clinical resources.
• Consult with management to overcome barriers in meeting goals.
• Utilize case management processes in compliance with policies.
• Ensure maximum member engagement through effective interviewing.

Skills

Clinical practice

MS Office

Education

Associate degree in nursing

Tools

MS Office Suite

Job description

About This Role

The Case Manager RN-Field position at CVS Health involves telephonically and face-to-face assessing, planning, implementing, and coordinating case management activities to evaluate and enhance the medical needs of members. This role is ideal for experienced RNs looking to make a significant impact in community health.

Highlights

• Location: Charleston, WV
• Schedule: Full-time, Monday – Friday, 8am-5pm
• Travel: 50% or more in the western region of WV
• Residency: Must reside in West Virginia
• Work Style: Field-based

What You'll Do

• Conduct face-to-face member visits
• Evaluate member's needs and benefit plan eligibility using clinical tools
• Apply clinical judgment to reduce risk factors and barriers
• Assess information from various sources for co-morbid conditions
• Review prior claims to impact current case management
• Assess the need for referrals to clinical resources
• Consult with management to overcome barriers in meeting goals
• Utilize case management processes in compliance with policies
• Ensure maximum member engagement through effective interviewing
• Communicate effectively, both verbally and in writing

Requirements

• Education:
• Associate degree in nursing or nursing diploma required
• Experience:
• 5+ years of clinical practice experience
• 2+ years of experience with personal computers and MS Office Suite
• Licenses & Certifications:
• Current unrestricted RN license in West Virginia or multi-state privilege license required

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on building a world of health around every individual, emphasizing innovation, accountability, and quality in their services.