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Position Summary

Normal Working Hours: Monday-Friday 10:30-7:00pm ET

There are no weekend hours.

There are no holiday coverage hours.

There is no travel.

This is a 100% remote work from home position and candidates from any state with a compact RN license can apply.

This position is for a high-risk maternity case management team and experience with this is required.

The Case Manager RN 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 within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey.

The Case Manager RN 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.

The Case Manager RN includes some of the following roles (not all inclusive):

-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 consider 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 interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

-Must hold an active and unrestricted RN License.

-Applicants must be willing and able to pursue multi-state licensure (paid for by the company).
-Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, maternity and/or OB-GYN office setting.

Preferred Qualifications

-Preferred RN licensure in a compact state:  Al, AR, AZ, CO, DE, FL, GA, IA, ID, IN, KS, KY, LA, MD, ME, MO, MS, MT, NC, ND, NE, NH, NJ, NM, OK, SC, SD, TN, TX, UT, VA, WI, WV, WY.

-1+ years of Case Management experience in an integrated model

-1+ years of experience with Telephonic Case Management

-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

Education

Associates Degree Nursing, BSN Preferred

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: 11/19/2024

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