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Position Summary

The Case Manager RN role is 100% remote work from home and candidates can reside in any state in US.

Working schedule is Monday-Friday. No nights, no weekends, no holidays. Must be open to working in MST, PST, OR Arizona time zones. 

As part of the care coordination team, the CVS Accountable Care RN Case 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 advance 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. 

Primary responsibilities include but not limited to the following:

• Serve as primary care manager for members identified for CVS Accountable Care
• Telephonically engage members to complete a holistic assessment of current health status and work collaboratively with the care team to manage the member’s most difficult symptoms and adaptation to their ongoing decline
• In collaboration with the multi-disciplinary team, develop and implement a care plan that addresses physical, behavioral and social needs
• Educate and assist member with advanced care planning, including establishing and end-of-life treatment plan
• Monitor and evaluate effectiveness of the care plan and modify plan in collaboration with multi-disciplinary team as necessary
• 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
• Make referrals to the Pharmacist for medication review and recommendations as indicated
• Make referrals to Social Worker and/or BH specialist as indicated

Required Qualifications

• 3+ years clinical experience required with at least 1 year of experience in one of the following areas: critical care, ICU, CCU, Emergency
• 2+ years of recent case management experience in one of the following settings required - health plan, hospice, or hospital setting.
• A Registered Nurse that must hold an unrestricted license in their state of residence, or able to get licensed with multi-state/compact privileges where applicable, and have the ability to be licensed in all non-compact states.

Preferred Qualifications

• Managed Care experience preferred
• Medicare experience preferred
• Advanced Care Planning Experience preferred
• CCM Certification
• 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

Education

Associate degree in nursing RN

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: 08/28/2024

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