Case Manager RN- Field - Case Management
Company: CVS Health
Location: Elmhurst
Posted on: March 20, 2023
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Job Description:
Case Manager RN- FieldJob Description
Prefers qualified candidates to reside in Elmhurst, Elmwood Park,
Hillside, Oak Park and Oak Brook cities of IL and surrounding
areas.
Nurse Case Manager is responsible for telephonically and 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 interviewing skills to ensure maximum member engagement
and discern their health status and health needs based on key
questions and conversation.
Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
Please keep in mind that this range represents the pay range for
all positions in the job grade within which this position falls.
The actual salary offer will take into account a wide range of
factors, including location.
Required Qualifications
* Minimum 3 years of clinical practice experience required.
* Active and unrestricted RN licensure in the state of IL
required.
* Willing and able to travel 50-75% of their time using their own
vehicle to meet members face to face in health facilities in
Elmhurst, Elmwood Park, Hillside, Oak Park and Oak Brook cities of
IL and surrounding areas.
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated
against COVID-19 (including any booster shots if required), where
allowable under the law, unless they are approved for a reasonable
accommodation based on disability, medical condition, religious
belief, or other legally recognized reasons that prevents them from
being vaccinated.
You are required to have received at least one COVID-19 shot prior
to your first day of employment and to provide proof of your
vaccination status or apply for a reasonable accommodation within
the first 10 days of your employment. Please note that in some
states and roles, you may be required to provide proof of full
vaccination or an approved reasonable accommodation before you can
begin to actively work.
Preferred Qualifications
* Case Management in an integrated model preferred
* Bilingual preferred.
* Experience working with adults with Behavioral Health and/or
medical needs
* Long Term care experience in Nursing Home setting is strongly
preferred required.
* MS office suite experience
Education
Associates Degree required; BSN preferred
Business Overview
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. We strive to promote and
sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal
opportunity employer, as are the physician-owned businesses for
which CVS Health provides management services. We do not
discriminate in recruiting, hiring, promotion, or any other
personnel action based on race, ethnicity, color, national origin,
sex/gender, sexual orientation, gender identity or expression,
religion, age, disability, protected veteran status, or any other
characteristic protected by applicable federal, state, or local
law. We proudly support and encourage people with military
experience (active, veterans, reservists and National Guard) as
well as military spouses to apply for CVS Health job
opportunities.
Keywords: CVS Health, Elmhurst , Case Manager RN- Field - Case Management, Executive , Elmhurst, Illinois
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