Field Case Management RN - Oklahoma

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary

This is a full-time field-based teleworker opportunity in Oklahoma. Must reside in the following or surrounding counties: Harmon, Greer, Jackson, Kiowa, Comanche, Caddo, Cotton, Grady, Stephens, Jefferson, Cleveland, McClain, Garvin, Murray, Carter, Lowe, Marshall, Johnston, Pottawatomie, and LincolnThe Case Manager, RN, utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member care. The CM RN leverages case management tools, such as assessment and care planning, direct provider coordination/collaboration, and coordination of wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Fundamental Components:

• Through the use of clinical tools and information/data review, conducts assessments of referred member's needs/eligibility and determines approach to meeting needs by evaluating available internal and external programs/services.
• Analyzes utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Follows members through their inpatient admission and continues oversight through transition from the acute setting to all other settings with the goal of reducing readmissions and increasing permanency in the community.
• Available to conduct face to face visits as necessary for high risk members.
• Ensures members transition upon discharge with adequate supervision, recommended behavioral health, physical health, pharmacy resources, and care management support.
• Educates and supports member/caregiver focusing on the seven primary areas: medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and advance directives.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
• Using a holistic approach consults with managers, medical directors and/or other programs as needed to overcome barriers to meeting goals and objectives.
• Presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• Engages and builds continued professional relationships at network facilities.
• Identifies and escalates quality of care issues through established channels.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member
• engagement and promotes 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.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
• Utilizes case management, utilization management, and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• Must reside within the region which includes the following or surrounding counties: Harmon, Greer, Jackson, Kiowa, Comanche, Caddo, Cotton, Grady, Stephens, Jefferson, Cleveland, McClain, Garvin, Murray, Carter, Lowe, Marshall, Johnston, Pottawatomie, and Lincoln
• RN with current unrestricted Oklahoma state licensure
• 3+ years of clinical practice experience (e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)
• 2+ years of demonstrated experience with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
• Must possess reliable transportation and be willing and able to travel in-state up to 50% of the time. Mileage is reimbursed per our company expense reimbursement policy.

• Managed care/utilization review experience
• Case management in an integrated model
• Discharge planning experience
• Experience providing care to American Indian/Indigenous American/Native American populations

• Minimum of Associate's degree or diploma nursing degree required
• BSN degree preferred