This role is work from home with travel required in Maricopa County, Arizona to visit members face to face.

Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members; Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
-Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
-Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care;
-Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
-Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
-Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
-Helps member actively and knowledgably participate with their provider in healthcare decision-making. Monitoring, Evaluation, and Documentation of Care;
-Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• Must reside in Maricopa County, AZ
• Active and unrestricted RN license in the state of Arizona.
• Willing and able to travel 50% of their time to meet members face to face within Maricopa County AZ and surrounding areas. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
• 2+ years clinical experience as a RN
• 2+ years of case management, discharge planning, and/or home healthcare experience

Preferred Qualifications

• Experience working with people who have been designated as having a serious mental illness (SMI) and e xperience working with people who are elderly or have a physical disability is very strongly preferred
• Computer proficient with MS Windows, Outlook, and Word
• Experience collaborating with medical professionals
• Strong organization and time management skills

Education

• Minimum Associate degree in Nursing or Diploma RN required
• BSN 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: 11/25/2024

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