Case Manager Registered Nurse (Field - Must reside in Woodford or McLean Counties Illinois)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
This Case Manager Registered Nurse position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Woodford and McLean County Illinois. The requirements is for candidates to hold an Illinois Registered Nurse License, and travel 50-75% of the time to meet with members face to face.

The typical work schedule is Monday- Friday 8am-5pm.

This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements.
 
Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.
 
Evaluation of Members:
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid 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 and/or healthcare needs.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and 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 knowledgeably 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
- 2+ years of clinical experience 
- Active and good standing Illinois RN license
- Must possess reliable transportation and be willing and able to travel 50-75% of the time to meet members face to face in Woodford and McLean Counties, and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.

- Must reside in Woodford or McLean County IL
 
Preferred Qualifications
- Case Management and Discharge Planning experience preferred
- Managed Care experience preferred
- Microsoft Office experience preferred
 
Education:
- Associates Degree required
- Bachelor's in Science & Nursing preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$66,575.00 - $142,576.00

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 factor