Position Summary

The CVS Accountable Care RN Care Manager will be the primary care manager for a selected member population. The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members across the continuum of care. The RN Case Manager utilizes advanced clinical judgement and critical thinking skills to effectively manage members through their illness with the goal of assuring the appropriate level of care is being provided, preventing Emergency Department visits and acute admissions, and ensuring the members physical, behavioral, and social needs are being appropriately addressed by the care team to achieve optimal clinical, financial, and quality of life outcomes. Using clinical tools and information/data review, conducts an evaluation of member's needs and applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators to manage the chronic conditions of members. This role is essential for improving patient outcomes and ensuring efficient use of healthcare resources.

Primary responsibilities include but not limited to the following:

• Serve as primary care manager for members identified for Care Management program
• Engage members to complete a holistic assessments of current health status and work collaboratively with the care team to manage the member's most difficult symptoms
• Collaboration with a multi-disciplinary team to develop and implement a care plan that addresses physical, behavioral, and social needs
• Educate and assist member with advanced care planning
• Monitor and evaluate effectiveness of the care plan
• Work with treating physicians to develop anticipatory symptom management plan and monitor for new issues/concerns/changes in pace of illness
• Prepare member/caregiver to understand and identify signs of functional decline and discuss long term plan for managing to help avert medical emergencies
• Ensure safe and appropriate transitions of care by collaborating with hospital discharge planners, outpatient provider, family/caregivers, and member, to ensure adequate caregiver assistance, functional support, medical follow up and medication oversight during transition from facility to home

Required Qualifications

Minimum of 3 years of professional/ clinical nursing experience, with a preference for experience in care coordination

2+ years of care management experience in one of the following settings required - health plan, hospice, home health or hospital setting.

A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges if living in a compact state, and willing to obtain licensure in other states.

Strong organizational, communication, and problem-solving skills; proficiency with electronic health records (EHR) systems

Excellent analytic and problem-solving skills

Ability to work independently (this position will be work from home)

Effective computer skills including navigating multiple systems and keyboarding.

Required Attributes

Empathy and Compassion: Essential for patient advocacy and support.

Attention to Detail: Critical for accurate documentation and care planning.

Adaptability: Ability to handle changing situations and patient needs.

Communication Skills: Strong verbal communication skills to effectively interact with patients, families, and healthcare providers over the phone

Organizational Skills: Excellent organizational and time management skills to handle multiple tasks and prioritize effectively

Technical Proficiency: Familiarity with electronic medical records (EMR) systems and other healthcare technologies

Interpersonal Skills: Compassionate and empathetic nature, with the ability to provide emotional support to patients

Preferred Qualifications

Managed Care, care coordination, case management, or a related field

EPIC experience

Medicare experience

Bilingual - English/Spanish

Chronic Disease care management

CCM Certification

Education

Active Registered Nurse (RN) license; a Bachelor's degree in Nursing (BSN) is preferred.

Location :

Remote in specified state

Pay Range

The typical pay range for this role is:

$61,360.00 - $132,600.00

This pay range represents the base 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.

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: 12/30/2024

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