Position Summary

This role is performed face-to-face/field-based and requires those in the position to travel at least 50% of the time outside of the home/office to various member homes, various facilities (such as nursing homes, rehab centers, etc.), or community meetings on a defined schedule, adhering to the defined metrics, as required by the business. Nurse Case Manager 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Responsibilities

• 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.

• This role is performed face-to-face/field-based and requires those in the position to travel at least 50% of the time outside of the home/office (e.g. member's home, nursing home, other facility).

• 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:

• Minimum 3+ years clinical practical experience

• Minimum 2+ years CM, discharge planning and/or home health care coordination experience

• Active and unrestricted Compact RN in SC

• Willing to travel 50% within Greenville, SC

Preferred Qualifications

• Excellent analytical and problem-solving skills

• Effective communications, organizational, and interpersonal skills.

• Ability to work independently (may require working from home).

• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

• Efficient and Effective computer skills including navigating multiple systems and keyboarding

Willing and able to obtain multi state RN licenses if needed, company will provide.

• Bilingual preferred - Spanish

• Certified Case Manager is preferred.

• Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required

Education

• Associate's degree or Nursing Diploma required

• Bachelor's degree preferred

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

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: 11/29/2024

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

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 through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.