Remote RN Case Manager - Telephonic Care Coordinator

NHSHP; Concord (NH); Teletrabalho; USD 54 000 - 156 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical insurance

Dental insurance

Vision coverage

Retirement savings options

Resumo da oferta

CVS Health is seeking a qualified RN Case Manager for a remote, nationwide role. You will deliver telephonic case management, evaluate medical necessity, and coordinate care with diverse care teams to support fully and self-insured clients.

The ideal candidate has 5+ years as an RN, valid multistate or state licenses, and experience with electronic documentation in complex clinical settings.

Qualificações

• 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting.
• A RN with a multistate license or state-specific licenses for the states supported.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or OB.

Responsabilidades

• This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Apply criteria and clinical guidelines to assess benefits and member needs for appropriate administration of benefits.
• Use clinical judgment to reduce risk factors and address complex health indicators affecting care planning.
• Assess information from various sources to address all conditions and related care needs.
• Consult with supervisor and teams to overcome barriers and discuss cases in conferences for multidisciplinary input.
• Collaborate with clinical colleagues to meet goals and objectives under regulatory standards.
• Use motivational interviewing to engage members and discern health status and needs.
• Escalate member needs following guidelines and protocols.
• Actively reach out to members to coordinate care and conduct medical necessity reviews.

Conhecimentos

Telephonic case management

Nursing expertise

Clinical assessment

Healthcare documentation

Formação académica

Nursing diploma or Associate Degree in Nursing

RN licensure (state or multistate via NLC)

Ferramentas

EMR systems

Descrição da oferta de emprego

CVS Health is seeking a qualified RN Case Manager for a remote, nationwide role. You will deliver telephonic case management, evaluate medical necessity, and coordinate care with diverse care teams to support fully and self-insured clients.

The ideal candidate has 5+ years as an RN, valid multistate or state licenses, and experience with electronic documentation in complex clinical settings.