Case Manager RN - Field (PA)

CVS Health; Harrisburg (Dauphin County); On-site; USD 60,000 - 130,000; Full time

Job summary

CVS Health is seeking a Case Manager RN to join their Community Care team. This full-time position requires an active PA RN license and involves significant travel across Pennsylvania to provide care coordination and support for members' health needs. The role offers a competitive salary and comprehensive benefits.

Benefits

Health insurance

401(k)

Stock purchase

Wellness programs

Qualifications

• Active and unrestricted PA Registered Nurse license.
• Minimum 3+ years of clinical experience.
• At least 2+ years in case management or home health care coordination.

Responsibilities

• Act as a liaison with members, families, and providers.
• Coordinate case management activities for chronically ill members.
• Assess and analyze medical and vocational status.

Skills

Analytical skills

Communication skills

Organizational skills

Interpersonal skills

Education

Associates degree

Tools

MS Office

Job description

Join to apply for the Case Manager RN - Field (PA) role at CVS Health

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 (i.e., hospitals) in Berks County, Chester County, and the Pittsburgh 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 a 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. Develop, implement, and support health strategies, tactics, policies, and programs that ensure the delivery of benefits and 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 Managers 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.

Responsibilities

• Act as a liaison with members, families, employers, providers, insurance companies, and healthcare personnel as appropriate.
• Coordinate case management activities relating to catastrophic cases and chronically ill members across the continuum of care, including referrals, home visits, community resources, and alternative care levels.
• Interact with members/clients telephonically or in person, potentially meeting in homes, worksites, or physicians’ offices.
• Assess and analyze medical and vocational status; develop care plans to optimize wellness, facilitate return to work, and determine benefit eligibility.
• Communicate with stakeholders and document all case work activities appropriately.
• Consult with multidisciplinary teams and healthcare providers to maximize health outcomes.
• Provide educational and preventive information for optimal medical results.
• Ensure compliance with laws and regulations related to rehabilitation services and insurance requirements.
• Evaluate members’ needs and facilitate services using clinical tools and data.
• Monitor progress and adjust care plans to enhance outcomes and overall wellness.

Minimum Qualifications

• Active and unrestricted PA Registered Nurse license.
• Minimum 3+ years of clinical experience, preferably in areas like diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care.
• At least 2+ years in case management, discharge planning, or home health care coordination.
• Ability to travel up to 75% for in-person case management activities.
• Reliable transportation.

Education

• Associates degree required.

Preferred Qualifications

• Strong analytical and problem-solving skills.
• Effective communication, organizational, and interpersonal skills.
• Ability to work independently and remotely.
• Proficiency with MS Office and proprietary applications.
• Bachelor’s degree preferred.
• Experience with discharge planning or home health care for Medicare members.
• Certification such as CCM, CRC, CDMS, CRRN, or COHN preferred.

Additional Details

• Anticipated weekly hours: 40
• Full-time employment
• Salary range: $60,522 - $129,615, depending on experience and location.
• Comprehensive benefits including health insurance, 401(k), stock purchase, wellness programs, and more.