Case Manager, Registered Nurse (Field – Clermont or Hamilton County, OH)

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Position Summary/Mission

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Fundamental Components/Job Description

• Evaluation of members-through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Enhancement of medical appropriateness and quality of care-using holistic approach consults with case managers, supervisors, medical directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits an/or healthcare needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement an promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Monitoring, evaluation and documentation of care
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Required Qualifications

• Candidate must reside in Clermont or Hamilton County, Ohio
• Must be willing and able to travel up to 75% in Clermont or Hamilton County Ohio
• Candidate must have an active and unrestricted Registered Nurse (RN) License in state of Ohio
• 3+ years of nursing experience

Preferred Qualifications

• Managed care experience
• Case management and discharge planning experience

Educational

• Associate's Degree in Nursing (REQUIRED)

License

• Active and unrestricted Registered Nurse (RN) License in state of Ohio

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

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