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Position Summary

This Case Manager RN position is 100% remote and the employee can live in any state.

Normal Working Hours: Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30am-7pm EST (1-2 times per quarter). Typical training hours are Monday-Friday 8-4:30 EST.

Nurse Care Manager 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.

-Develops a 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.

- Services strategies policies and programs are comprised of network management and clinical coverage policies.

- Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that 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 others 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 MI skills to ensure maximum member engagement and discern their health status.

Required Qualifications

- Must have an active current and unrestricted RN license in state of residence. With the willingness and ability to obtain additional state licenses upon hire (paid for by the company)

- 5+ years of acute care experience as an RN required

- Must be willing and able to work Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30AM to 7PM EST

Preferred Qualifications
- Compact State licensure preferred.

- CCM certification preferred.

- Managed care case management preferred.

- Home Care Experience preferred.

- Strong Computer Skills preferred.

- Microsoft Suite familiarity preferred.

- Spanish speaking/bilingual.

Education
Associate's with RN licensure required; BSN preferred

Pay Range

The typical pay range for this role is:

$60,522.80 - $129,615.20

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: 10/16/2024

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