Clinical Case Manager, RN Field - Bilingual - Miami, FL

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

The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).  The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. 

The Case Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) for a Medicaid population in Dade and Monroe Counties, FL.

What you will do

·       Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.

·       Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.

·       Handles reviews of prior claims to address potential impact on current case management and eligibility.

·       Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.

·       Ensures case management processes follow organization and regulatory requirements.

·       Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.

·       Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Required Qualifications

• Must reside in Miami Dade, FL or a surrounding county
• Bilingual in Creole and/or Spanish
• Active current unrestricted RN licensure in the state of Florida
• 3+ years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility 
• Willing and able to travel 10-20% of their time to meet members face to face in the Miami Dade County and surrounding areas. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

 

Preferred Qualifications

• ​Chronic disease management preferred (cancer, diabetes, hypertension, chronic kidney disease, serious mental illness, and/or HIV aids)
• Case management in an integrated model preferred
• Managed care experience
• Discharge planning experience
• Experience providing care to the Medicaid population

Education

• Associates degree or Diploma in Nursing required
• BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00