Case Manager RN- Afternoon shift

About the position The Case Manager RN position at CVS Health is a remote role focused on assessing, planning, implementing, and coordinating case management activities to enhance the overall wellness of members. The RN will utilize clinical tools and data to evaluate medical needs, facilitate transitions to Aetna's programs, and apply clinical judgment to address health and social indicators impacting care planning. This position operates within Aetna's Commercial Care Management division and requires strong telephonic communication skills and a proactive approach to member engagement.

Responsibilities

• Telephonically and/or face-to-face assess, plan, implement, and coordinate all case management activities with members.

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• Develop proactive courses of action to enhance short and long-term outcomes for members.

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• Conduct evaluations of member needs and benefit plan eligibility 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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• Review prior claims to assess their impact on current case management and eligibility.

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• Assess members' work capacity and related restrictions/limitations.

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• Utilize a holistic approach to determine the need for referrals to clinical resources.

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• Consult with supervisors and present cases at case conferences for multidisciplinary focus.

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• Utilize case management processes in compliance with regulatory and company policies.

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• Engage members through effective interviewing skills to discern their health status and needs.

Requirements

• Active current and unrestricted RN licensure in the state of residence.

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• Willingness to obtain multiple state RN licensure after hire (expenses paid by company).

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• 2+ years as an RN with med/surge experience, Emergency Department, and Telemetry.

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• Willingness to work Monday - Friday 9:00 am - 5:30 pm.

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• Willingness to work late shift once per quarter until 9 pm.

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• 1+ year experience with Microsoft Office including PowerPoint, Excel, and Word.

Nice-to-haves

• 2+ years of Case Management experience.

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• Strong telephonic communication skills.

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• Certified Case Manager (CCM) certification.

Benefits

• Medical, dental, and vision benefits.

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• 401(k) retirement savings plan.

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• Employee Stock Purchase Plan.

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• Fully-paid term life insurance plan.

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• Short-term and long-term disability benefits.

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• Well-being programs.

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• Education assistance and free development courses.

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• CVS store discount and discount programs with partners.

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• Paid Time Off (PTO) and paid holidays.

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