Case Manager RN- High Point, NC

CVS Health Corporation; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

CVS Health Corp. is seeking an RN Case Manager to work remotely from North Carolina, coordinating telephonic case management for members and ensuring quality care.

The role follows standard hours with some evenings and holidays as needed, and occasional travel to the High Point office may be required for meetings if within 30 miles. Responsibilities include assessing patient needs, coordinating plans, and guiding members through eligible CVS Health programs while upholding HIPAA guidelines and

Qualifications

• 2+ years of clinical experience as an RN.
• 3+ years' experience with Microsoft Office Suite.
• Case management in an integrated model is preferred.
• BSN preferred or required in some cases.
• Certified Case Manager (CCM) certification is preferred.

Responsibilities

• Telephonically assess, plan, implement and coordinate all case management activities.
• Evaluate medical needs and facilitate the member's overall wellness.
• Review prior claims to assess impact on case management and eligibility.
• Assess work capacity and related restrictions/limitations.
• Consult with supervisor to overcome barriers and present cases at conferences.

Skills

RN experience

Case management

Integrated care

Education

BSN

Tools

Microsoft Office Suite

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary:

The Case Manager RN role is telework and must be located in North Carolina.

Normal Working Hours: Monday through Friday 9:00am - 5:30pm EST.

Occasional evening, and holiday shifts per the needs of the team.

0-10% travel possible including but not limited to travel to the High Point office for customer meetings if you reside within 30 miles.

The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

RN Case Manager:

• 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 overall wellness through integration.
• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications:

• Must live in North Carolina
• Must have an active and unrestricted RN license in the state of North Carolina.
• Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company)
• 2+ years of clinical experience as an RN
• All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.

Preferred Qualifications:

• Certified Case Manager (CCM) certification
• 3+ years' experience with Microsoft Office Suite
• Case Management in an integrated model
• Discharge Planning experience
• Managed care experience
• BSN

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong