Case Manager RN

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Position Summary:

This Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states.

Normal Working Hours: Monday through Friday 9:00am through 5:30pm in time zone of residence

There is no travel expected with this position.

The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

RN Case Manager:

• 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 overall wellness through integration.

• Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

• Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

• Reviews prior claims to address potential impact on current case management and eligibility.

• Assessments include the member’s level of work capacity and related restrictions/limitations.

• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

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

• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications:

• Must have active, current and unrestricted RN Licensure in state of residence

• 3+ years clinical practice experience required

• Must be able to work Monday through Friday 9:00am to 5:30pm EST zone time zone of residence

• Must be able to work occasional holiday on-call as needed

Preferred Qualifications:

• Compact RN licensure

• Case management experience

• Bilingual in Spanish and English

• Case Manager Certification

• Experience with using Windows/ Microsoft Office

• Strong computer skills

Education:

Associates Degree required

BSN Preferred

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

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. 
 
In addition to your compensation, enjoy the reward