At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.This Case Manager RN role is fully remote; however, candidates must reside within 45 minutes (reasonable driving distance) from the local office located at 7034 Alamo Down's Pkwy, San Antonio, TX 78238Must be able to work Monday through Friday 8:00am-5:00pm CST with flexibility to rotate to 10:00am-7:00pm CST on occasion when required to meet business needs. No weekends or holidays will be requiredThe Case Manager RN 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.The Case Manager RN develops 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.The Case Manager RN job duties include (not an all-encompassing list).
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-Through the use of clinical tools and information/date review, conducts an evaluation of members needs and benefit plan eligibility and facilities integrative functions as well as smooth transition to Aetna programs and plans.
- Applies clinical judgement to the incorporation of strategies designed to reduce risk factors and barriers and address complex issues and social indicators which impact care planning and resolution of member issues.
-Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnosis the 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 other 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 conversations.Required Qualifications
- Must have current and unrestricted RN multi-state licensure in Texas and willingness to obtain additional state licenses will be required upon hire (expenses will be covered by the company).
- 3+ years clinical practice experience as an RN is required
- 1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications
- Must reside within 45 minutes (reasonable driving distance) from the local office located at 7034 Alamo Downs Parkway, San Antonio, TX 78238
- Must be willing and able to travel to the San Antonio office (if required) for occasional quarterly meetings or PRN meetings
- Must be able to work Monday through Friday 8:00am-5:00pm CST with flexibility to rotate to 10:00am-7:00pm CST on occasion when required to meet business needs
- Case Management in an integrated model
- Bilingual in Spanish and English
- Strong computer skills
- Associate Degree required
- BSN preferred
40Time Type
Full timePay Range
The typical pay range for this role is:$60,522.00 - $129,615.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.