Case Manager RN - Field

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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 Ohio or within commuting distance of Toledo, Ohio

50-75% of expected travel throughout Toledo, Ohio

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

CVS Accountable Care Field Case Manager uses 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.

The CVS Accountable Care RN Care Manager will be the primary care manager for a selected member population. The RN Case Manager is responsible for both telephonically and in person assessing, planning, implementing, and coordinating all case management activities with members across the continuum of care. The RN Case Manager utilizes advanced clinical judgement and critical thinking skills to effectively manage members through their illness with the goal of assuring the appropriate level of care is being provided, preventing Emergency Department visits and acute admissions, and ensuring the members physical, behavioral, and social needs are being appropriately addressed by the care team to achieve optimal clinical, financial, and quality of life outcomes. Using clinical tools and information/data review, conducts an evaluation of member's needs and applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators to manage the chronic conditions of members. This role is essential for improving patient outcomes and ensuring efficient use of healthcare resources.

Primary responsibilities include but not limited to the following:

• Serve as primary care manager for members identified for Care Management program
• Engage members to complete a holistic assessments of current health status and work collaboratively with the care team to manage the member’s most difficult symptoms
• Collaboration with a multi-disciplinary team to develop and implement a care plan that addresses physical, behavioral, and social needs
• Educate and assist member with advanced care planning
• Monitor and evaluate effectiveness of the care plan
• Work with treating physicians to develop anticipatory symptom management plan and monitor for new issues/concerns/changes in pace of illness
• Prepare member/caregiver to understand and identify signs of functional decline and discuss long term plan for managing to help avert medical emergencies
• Ensure safe and appropriate transitions of care by collaborating with hospital discharge planners, outpatient provider, family/caregivers, and member, to ensure adequate caregiver assistance, functional support, medical follow up and medication oversight during transition from facility to home

Required Qualifications

Minimum of 3 years of professional/ clinical nursing experience, with a preference for experience in care coordination

2+ years of telephonic and/ or field care management experience required.

A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges if living in a compact state, and willing to obtain licensure in other states.

Strong organizational, communication, and problem-solving skills; proficiency with electronic health records (EHR) systems

Excellent analytic and problem-solving skills

Ability to work independently (this position will be work from home)

Effective computer skills including navigating multiple systems and keyboarding.

Required Attributes

Empathy and Compassion: Essential for patient advocacy and support.

Attention to Detail: Critic