Case Manager - Registered Nurse - Southeast Region

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

• Candidates must live in the Southeast Region (States Include- FL, GA, AL, MS, NC, SC, TN, AR, LA)
• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence
• 3+ years clinical practical experience with preference in the following areas: diabetes, Congestive Heart Failure (CHF), Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members
• 2+ years case management, discharge planning and/or home health care coordination experience
• 2+ years of experience with Microsoft Word, Excel, and Outlook

Preferred Qualifications

• Previous work from home experience in a healthcare related field
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM)
• Efficient and effective computer skills including navigating multiple systems and keyboarding

Education

• Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

License

• Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence

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