Field Case Manager RN- Chicago Metro Area

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

Requirement to reside in Chicago, Illinois or within commuting distance of the greater Chicago Metro area

75% of expected travel throughout the Chicago Metro Area. Most be willing to travel up to 50 to 75 miles.

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

CVS Accountable Care Field Case Manager uses a collaborative process of 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

• Acts as a liaison with beneficiary, family, provider(s), and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill beneficiary 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 beneficiaries telephonically or in person. May be required to meet with beneficiaries in their homes, physician’s office, or CVS Health Hub to provide ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill beneficiaries medical status; In collaboration with the provider partner develops a plan of care to facilitate the beneficiary 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 beneficiary and other stakeholders as appropriate (e.g., medical providers, attorneys, community resources) 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 beneficiary maximize best health outcomes.
• Collaborate with 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 Medicare and referral sources.
• Conducts an evaluation of beneficiary’s 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 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 beneficiary’s overall wellness through integration.
• Monitors beneficiary progress toward desired outcomes through assessment and evaluation

Required Qualifications

• A Registered Nurse that must hold an unrestricted license in Illinois
• 3+ years clinical experience required with at least 1 year of experience in one of the following areas: critical care, ICU, CCU, Emergency
• 2+ years case management experience required
• Must be willing to travel up to 75% throughout the greater Chicago Metro Area and okay with traveling 50 to 75 miles.
• Reliable transportation required - Mileage is reimbursed per our company expense reimbursement policy
• Intermediate to Advance computer skills including easily navigating multiple programs/systems ( Outlook, Word, Excel, TEAMS, EMR) and keyboarding skills

Preferred Qualifications

• Managed Care experience preferred
• Medicare experience preferred
• Advanced Care Planning Experience preferred
• CCM Certification
• Excellent analytic and problem-solving skills
• Experience with work independently (this position