Case Manager RN - Maricopa County - Arizona

CVS Health; Phoenix (AZ); Remote; USD 60,000 - 130,000; Full time

Job description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Position Summary

SIGN ON BONUS - Qualifying candidates may be eligible for up to a $5,000 sign on bonus upon hire.

This position requires the ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must reside in Maricopa County and have reliable transportation, and proof of vehicle insurance. Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require meeting after school, after work, etc.

The Nurse Case Manager is a full-time teleworker position that requires some travel. This position is responsible for telephonically and/or face to face 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. 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.

Fundamental Components

1. 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.
2. 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.
3. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
4. Reviews prior claims to address potential impact on current case management and eligibility.
5. Assessments include the member’s level of work capacity and related restrictions/limitations.
6. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
7. 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.
8. Utilizes case management processes in compliance with regulatory and company policies and procedures.
9. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
10. Typical office working environment with productivity and quality expectations.
11. Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
12. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
13. Multitasks, prioritizes and effectively adapts to a fast-paced changing environment.
14. Demonstrates proficiency with computer skills which includes navigating multiple systems and keyboarding.
15. Demonstrates effective communication skills, both verbal and written.

Required Qualifications

1. RN with current unrestricted state licensure required.
2. 5 years’ clinical practice experience.
3. Must be Arizona based and willing and able to travel 10% of the time in Maricopa County. Mileage will be reimbursed per company policy.

Preferred Qualifications

1. Case Management in an integrated model preferred.
2. Bilingual in Spanish preferred.
3. Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.

Education

1. Minimum of an Associates degree required.
2. Bachelor's Degree preferred.

Pay Range

The typical pay range for this role is: $60,522.80 - $129,600.00. 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.

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.