Case Manager Registered Nurse - Field (Michigan)

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 role will be 25-50%% travel within Barry, Van Buren, Kalamazoo, Calhoun, Berrien, Cass, St. Joseph, and Branch Counties.  This is a work from home position.
Schedule: Standard business hours - 8:00AM-5:00PM, no night, weekend, or holiday shifts!

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.

Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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.  

Fundamental Components

• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
• Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

• Minimum 3-5 years clinical practical experience required
• Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience required
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise - when COVD-19 restrictions shift
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding

Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Preferred Qualifications

• Certified Case Manager is preferred.

Education

• Registered Nurse with active MI state license in good standing

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

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 factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term