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.

The Onsite Sr Clinical Consultant, RN collaborates with Gwinnett County Board of Commissioners’ onsite Employee Wellness Center, HR Benefits team and Aetna’s Aetna One Advisor (A1A) team to establish and implement efficient and effective delivery of healthcare services. Serves as an extension of the A1A team by assisting in the management of coordinating patient care, implementing quality improvement initiatives, and maintaining regulatory compliance. Collaborates with interdisciplinary teams and contributes to enhancing patient outcomes and overall operational excellence. Acts as a liaison between Gwinnett County’s onsite Employee Wellness Center vendor and Aetna One Advisor Team. Assist patients with enrollment and education of clinical programs as well as other vendor solutions within Gwinnett County.  Analyze utilization data to develop recommendations for future employee wellness programs.

The Onsite Sr Clinical Consultant, RN role is a full-time, client-based position working onsite at Gwinnett County Board of Commissioners. Work schedule aligns with the Gwinnett Employee Wellness Center hours of operation. Must be flexible to modify work schedule to start earlier or work later with potential evening and weekend hours for special events with advanced notice. Hours may change depending on business strategy.

Limited travel of up to 25-% to meet with members at various worksites across Gwinnett County. 

What you will do:

• Utilizes clinical skills and experience to coordinate, document, and communicate essential aspects of the A1A and benefits management program.
• Utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote/influence members in decisions related to achieving and maintaining optimal health status.
• Conducts proactive outreach based on the needs of the population, wellness and prevention for age-appropriate health screenings, cost-effective choices and health plan benefits.
• Consults and lends Clinical expertise to key internal and external constituents in the coordination and administration of benefits management initiatives and objectives.
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services and benefits for members. Handles warm call transfers to the A1A team.
• Works closely with the A1A team, and onsite Employee Wellness Center vendor to enhance the member experience. Proactively provides guidance and support encouraging members to engage in care management programs, point solution programs, as well as recommendations for other available programs available to Gwinnett County members.
• Responds to inquiries on benefit plan structure, member cost share for medical and pharmacy services, claims review, prior authorization and connects members to the right resources to address all health care needs. Works internally to obtain support to resolve complex issues.
• Leverages the information available to assist in member education, identification of organization specific values, mission, vision and goals for holistic wellbeing.  Connects members to social worker, nutritionists and other providers to improve overall wellbeing.
• Promotes and attends health screenings. Provides general health and preventive screening education and resources at employer worksites as well as track and trend data.
• Confers internally and externally with clients and senior management regarding the organization's goals and objectives.
• Learns and displays the Gwinnett County standard in all activities and interactions. 
• Collaborates with the Gwinnet Team to initiate programs identified by the top clinical conditions (diabetes, obesity, hypertension, muscular skeletal, etc.). Evaluate utilization patterns based on client specific data to form recommendations on future solutions.
• Attends and consults during utilization meetings
• Collaborates with the Plan Sponsors wellness team on activities for monthly health observance (i.e. breast cancer, men’s health awareness). This work results in initiatives that significantly impact workplace well-being strategy, enabling the organization to be competitive in the marketplace and effectively serve its customers.
• Partners with Public and Labor Account Management team to optimize customer satisfaction and retention.

Required Qualifications:

• A Registered Nurse that must hold an unrestricted license in Georgia, with multi-state/compact privileges and be willing and able to be licensed in all non-compact states, as needed where membership resides. Maintain RN licenses as required for employment.
• 3+ years of clinical practice experience required as an RN.
• There is a requirement to live within a commutable distance of plan sponsor’s onsite Employee Wellness Center located in Lawrenceville, GA (typically within 45 minutes maximum).

Preferred Qualifications:

• Case Management in an integrated model working with employer programs.
• Certified Case Manager (CCM) certification
• Advanced problem solving and decision-making skills.
• Advanced knowledge of medical terminology.
• Advanced collaboration and teamwork skills.

Education:

• Bachelor of Science in Nursing required and Masters preferred

Pay Range

The typical pay range for this role is:

$60,300.00 - $173,040.00

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: 10/30/2024

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