Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Case Manager RN is responsible for providing comprehensive care management services to members with complex medical, behavioral health, and social needs.
Responsibilities The role includes conducting clinical assessments, developing and monitoring person-centered care plans, coordinating care across providers and community resources, facilitating transitions of care, identifying and addressing barriers to health outcomes, and ensuring members receive medically necessary and cost-effective services.
Requirements
- Active and unrestricted Registered Nurse (RN) license in the applicable state.
- Minimum of 3 to 5 years of clinical nursing experience, preferably in care management, case management, home care, long-term care, managed care, utilization management, or community-based healthcare settings.
- Experience coordinating care for members with complex medical, behavioral health, and psychosocial needs.
- Strong knowledge of chronic disease management, care coordination, and healthcare delivery systems.
- Ability to perform clinical assessments, identify member needs, and develop comprehensive care plans.
- Excellent communication, organizational, critical thinking, and problem-solving skills.
- Proficiency in Microsoft Office applications and electronic documentation systems.
- Ability to work independently while effectively collaborating with interdisciplinary teams.
Preferred Qualifications
- Certified Case Manager (CCM) certification or willingness to obtain certification.
- Experience working in Managed Long-Term Care (MLTC), Medicare, Medicaid, Dual Eligible, or other managed care populations.
- Knowledge and experience with the Uniform Assessment System (UAS-NY) and person-centered service planning.
- Experience coordinating home and community-based services (HCBS), long-term services and supports (LTSS), and behavioral health services.
- Bilingual skills preferred.
- Experience working in a remote or field-based care management environment.
Work from Home Requirements
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
- A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted.
- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.).
- All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work from Home requirements.
Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.