Case Manager RN (Remote) at CVS Health

About the position

At CVS Health, we are dedicated to bringing our heart to every moment of your health. This commitment drives our mission to deliver enhanced human-centric health care in a rapidly changing world. Our purpose is not just about what we deliver, but how we deliver our services, ensuring that every interaction is meaningful and impactful. Our Heart At Work Behaviors empower our employees to play a vital role in transforming our culture and accelerating our ability to innovate and provide solutions that make health care more personal, convenient, and affordable. In this full-time telework role, you will work Monday through Friday from 8 AM to 5 PM EST. As a Nurse Care Manager at Aetna, you will be at the forefront of serving dual eligible populations, utilizing best-in-class operating and clinical models. You will collaborate with members, providers, and community organizations to address the full continuum of health care and social determinant needs for our members enrolled in Dual Eligible Special Needs Plans (DSNP). Your primary responsibility will be to assess, plan, implement, and coordinate all case management activities for our members. You will evaluate their medical needs and develop proactive care plans to enhance both short and long-term outcomes. By using clinical tools and data review, you will conduct thorough evaluations of member needs and benefits, applying clinical judgment to reduce risk factors and address complex health and social indicators that impact care planning. You will also conduct assessments that consider various sources of information, including claims, to address co-morbid conditions and multiple diagnoses that affect functionality. In this role, you will utilize motivational interviewing skills to engage members effectively, ensuring that their health status and needs are accurately discerned. You will work closely with your supervisor and interdisciplinary team members to overcome barriers and achieve goals, presenting cases at interdisciplinary case conferences and ensuring compliance with regulatory and company policies and procedures.

Responsibilities
? Assess, plan, implement, and coordinate all case management activities with members.
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? Evaluate the medical needs of members to facilitate overall wellness.
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? Develop proactive plans of care to address identified issues and enhance outcomes.
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? Conduct evaluations of member needs and benefits using clinical tools and data review.
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? Apply clinical judgment to reduce risk factors and address complex health and social indicators.
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? Conduct assessments considering various sources of information, including claims.
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? Utilize motivational interviewing skills to engage members and discern their health needs.
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? Consult with supervisors and interdisciplinary team members to overcome barriers and meet goals.
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? Present cases at interdisciplinary case conferences.
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? Ensure compliance with regulatory and company policies and procedures.

Requirements
? Active and unrestricted RN licensure in state of residence.
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? 3+ years of clinical experience.
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? 2+ years of Case Management, Discharge Planning, and/or Home Healthcare Coordination experience.

Nice-to-haves
? Certified Case Manager
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? Excellent analytical and problem-solving skills.
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? Bilingual (English / Creole or English / Spanish) is desired.
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? Effective communications, organizational, and interpersonal skills.
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? Ability to work independently.
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? Effective computer skills including navigating multiple systems and keyboarding.
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? Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications.

Benefits
? Full range of medical, dental, and vision benefits.
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? 401(k) retirement savings plan.
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? Employee Stock Purchase Plan for eligible employees.
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? Fully-paid term life insurance plan for eligible employees.
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? Short-term and long-term disability benefits.
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? Numerous well-being programs and education assistance.
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? Free development courses.
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? CVS store discount and discount programs with participating partners.
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? Paid Time Off (PTO) and paid holidays throughout the year.