Normal Working Hours: 8:00am through 4:30pm in the time zone of residence with a 10:30am-7:00pm EST rotation several times per Quarter.

Rotational coverage of evenings, weekends and holidays will be per the needs of the department.

No travel is expected with this position.

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills.

The responsibilities of this Case Manager RN position are to:

-Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.

-Conduct comprehensive clinical assessments.

-Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services.

-Advocate for patients to the full extent of existing health care coverage.

-Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency.

-Identify and escalate quality of care issues through established channels.

-Provide an expected very high level of customer service.

-Utilize assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.

-Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

-Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Required Qualifications:

• Must hold an active and unrestricted RN license in their state of residence
• Willing and able to obtain additional state licensures upon hire (company paid)
• 3+ years of acute care experience as an RN
• 2+ years' experience in case management, home health, or hospice
• 3+ years of experience with Microsoft Suite of products

Preferred Qualifications:

• Compact RN License
• Certified Case Manager (CCM)
• Managed Care experience
• Telephonic case management and/or telephonic customer service center experience

Education:

• Associate Degree in Nursing required
• BSN preferred

Pay Range

The typical pay range for this role is:

$66,575.08 - $142,576.72

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/04/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.