CVS Accountable Care - Field Case Manager RN Long Island, NY

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary
$3,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS.

Requirement to reside on Long Island, New York, or within commuting distance of Long Island.

50-75% of time will be spent in provider offices or beneficiaries home visit Long Island, NY.

Working schedule is Monday-Friday; will work between 8am - 6pm EST.

The Hybrid Case Manager works in the field in provider offices, skilled nursing facilities, hospitals, or beneficiary’s homes, using a collaborative process of coordination of care, assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Fundamental Components & Physical Requirements:
* Collaborates with the ACO provider partners in their office(s) to determine which beneficiaries would benefit most from case management services. Communicates with the provider partner(s) as to course of care and treatments as appropriate.

Can act in the role of embedded case manager within the provider partner(s) offices to meet with the beneficiaries in conjunction with their provider appointments.

Can at in the role of care coordinator and clinical team liaison as beneficiaries are preparing for facility discharges.

* Acts in the role of embedded case manager within the provider partner(s) offices to meet with the beneficiaries in conjunction with their provider appointments.
* Implements and coordinates all case management activities relating to catastrophic cases and chronically ill beneficiaries 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 in the provider partner(s) offices.
* May be required to interact with beneficiaries via telephone, if unable to meet with the beneficiary during physician visits and to provide ongoing case management services.
* Assesses and analyzes injured, acute, or chronically ill beneficiaries medical and/or vocational status; develops a plan of care to facilitate the beneficiaries appropriate condition management to optimize wellness and medical outcomes, aid in optimal functioning, and determination of eligibility for benefits as appropriate.
* Communicates with beneficiary 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, consults, and make appropriate referrals to/with internal multidisciplinary team as indicated to help beneficiary maximize best health outcomes.
* 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 Medicare and referral sources.
* Conducts an evaluation of beneficiaries needs 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.