Case Manager RN - Field (PA)

The Muse; Chester Springs (PA); On-site; USD 60,000 - 130,000; Full time

Job summary

A leading health solutions company is seeking a Case Manager RN to join its Community Care team in Pennsylvania. This role involves traveling to various healthcare facilities, addressing patient care needs, and utilizing clinical models to improve outcomes. The ideal candidate will possess strong assessment skills and have experience in managing chronic conditions. You will be pivotal in facilitating wellness programs and ensuring comprehensive health management for members.

Benefits

401(k) plan with company contributions

Wellness programs and counseling

Flexible work schedules

Tuition assistance

Qualifications

• Minimum 3+ years clinical experience preferred (diabetes, CHF, CKD).
• Minimum 2+ years case management experience.
• Willingness to travel up to 75% in Pennsylvania.

Responsibilities

• Assesses and analyzes patients' medical and vocational status.
• Coordinates case management activities for chronically ill members.
• Communicates care plans to stakeholders to ensure quality outcomes.

Skills

Analytical Problem-Solving

Effective Communication

Organizational Skills

Interpersonal Skills

Education

Active and unrestricted Registered Nurse PA license

Associates degree

Bachelor's degree

Tools

Standard corporate software applications

Job description

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Join to apply for the Case Manager RN - Field (PA) 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. Schedule:

Monday-Friday 8AM - 5PM

Travel:

Up to 55-75% travel in Pennsylvania to various facilities (ie: hospitals) in Berks County, Chester County and the Pittsburg area to meet with members

Program Overview

Help 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.Family Summary/Mission

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.Position Summary/Mission

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.

Fundamental Components & Physical Requirements Education Anticipated Weekly Hours

• 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 Registered Nurse PA license
• Minimum 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac)
• Minimum 2+ years CM, discharge planning and/or home health care coordination experience
• Ability to travel for in-person case management activities
• Must possess reliable transportation and be willing and able to travel up to 75% of the time to various facilities. Mileage is reimbursed per our company expense reimbursement policy
• Associates degree required Preferred Qualifications
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently and comfortable 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
• Bachelor's degree
• Discharge planning or home health care with Medicare members
• Certified Case Manager or Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)
  
  

40Time Type

Full timePay Range

The typical pay range for this role is:$60,522.00 - $129,615.00This 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: 05/30/2025Qualified 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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