Remote RN Case Manager: Holistic Care Navigator

CVS Health; Guin (AL); À distance; USD 61 000 - 130 000; Plein temps

Résumé du poste

CVS Health is seeking a Case Manager - Registered Nurse (RN) for a fully remote role within the National Medical Excellence (NME) team. The RN will conduct telephonic and face-to-face assessments, plan, implement, and coordinate case management activities to evaluate members' medical needs and promote their wellness.

The blended role covers Case Management and Utilization Management. The ideal candidate has an active compact RN license, 5 years of RN practice, 2+ years in critical care, and at

Qualifications

• Active, current and unrestricted compact RN licensure in residence state.
• 5 years clinical RN experience.
• 2+ years in critical care.
• 6+ months case management or utilization management experience.
• Must be able to work Monday - Friday 8 AM to 5 PM in residence time zone.
• Must be able to obtain multi-state RN licensures.

Responsabilités

• Develops a proactive course of action to address issues and enhance outcomes and overall wellness.
• Evaluates member needs and benefit plan eligibility and facilitates transitions to Aetna programs.
• Applies clinical judgment to strategies to reduce risk factors and barriers to care planning.
• Assesses information from various sources to address all conditions impacting functionality.
• Reviews prior claims to assess potential impact on case management and eligibility.
• Assesses work capacity and related restrictions/limitations.
• Uses holistic assessment to determine referrals to clinical resources as needed.
• Consults with supervisor and case conferences to improve outcomes and manage care.
• Follows regulatory and company policies in case management processes.
• Uses interviewing skills to maximize member engagement and determine health needs.

Connaissances

RN licensure

Critical care

Case management

Multistate licensure

Work schedule

Formation

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Description du poste

CVS Health is seeking a Case Manager - Registered Nurse (RN) for a fully remote role within the National Medical Excellence (NME) team. The RN will conduct telephonic and face-to-face assessments, plan, implement, and coordinate case management activities to evaluate members' medical needs and promote their wellness.

The blended role covers Case Management and Utilization Management. The ideal candidate has an active compact RN license, 5 years of RN practice, 2+ years in critical care, and at