Case Manager

We are seeking a Case Manager to join our team at CVS Health. As a Case Manager, you will coordinate and facilitate comprehensive care for individuals by assessing their needs, developing personalized care plans, and coordinating services across healthcare providers. You will serve as an advocate for patients, ensuring effective communication, resource utilization, and continuous monitoring of their progress to promote positive outcomes and enhance overall well-being.

Responsibilities:

• Act as a liaison with members/clients/families, employers, providers, insurance companies, and healthcare personnel as needed.
• Implement and coordinate case management activities for catastrophic cases and chronically ill members/clients.
• Interact with members/clients telephonically or in person, and may be required to meet with them in their homes, worksites, or physician's offices.
• Assess and analyze injured, acute, or chronically ill members/clients' medical and/or vocational status, and develop a plan of care to facilitate condition management.
• Communicate with members/clients and other stakeholders as needed.
• Prepare required documentation of case work activities.
• Interact and consult with internal multidisciplinary teams to help members/clients maximize best health outcomes.
• Make outreach to treating physicians or specialists concerning course of care and treatment as needed.
• Provide educational and prevention information for best medical outcomes.
• Apply laws and regulations related to rehabilitation services, and follow special instructions from insurance carriers and referral sources.
• Conduct evaluations of members/clients' needs and benefit plan eligibility, and facilitate integrative functions using clinical tools and information/data.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Facilitate condition management, optimize overall wellness and medical outcomes, and aid timely return to work or optimal functioning.
• Develop a proactive course of action to address issues and enhance short- and long-term outcomes.
• Monitor member/client progress toward desired outcomes through assessment and evaluation.

Requirements:

• Active and unrestricted Compact Registered Nurse (RN) Licensure in Florida or Ohio.
• 3+ years of clinical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or home health with Medicare members.
• 2+ years of case management, discharge planning, or home health care coordination experience.
• Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint.
• Ability to work in a fast-paced, high-volume environment and utilize time management and prioritization skills.
• Efficient and effective computer skills, including navigating multiple systems and keyboarding.
• Working knowledge of problem-solving and decision-making skills, medical terminology, and digital literacy skills.
• Ability to deal tactfully with customers and community, handle sensitive information ethically and responsibly, and consider the relative costs and benefits of potential actions.

Preferred Qualifications:

• National professional certification (CRC, CDMS, CRRN, COHN, or CCM).
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Bilingual - Spanish.

Education:

• Associate's Degree in Nursing (required).
• Bachelor's Degree in Nursing (preferred).

Work from Home Requirements:

• Direct/hardwired internet connection to a modem/router within 7 feet of computer.
• Quiet, secure, and private designated home virtual work location.
• Minimum download speed of 25 mbs and upload speed of 3 mbs.

Technical and Logistical Requirements:

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
• Ability to log in to secure systems, lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently.

Anticipated Weekly Hours: 40 Time Type: Full-time Pay Range: $60,522.00 - $129,615.00