Case Manager Registered Nurse/Licensed Practical Nurse (Field – Must reside in Central Virginia)

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 Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Central Virginia. The requirements is for candidates to hold a Virginia RN, LPN, or BH License, and travel up to 50-75% of the time to meet with members face to face.

Typical office working environment with productivity and quality expectations

Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. 

Work requires sitting for extended periods, talking on the telephone, and typing on the computer

Nurse Case Manager is 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. 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 member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. 

Required Qualifications

• Candidate must reside in Central Virginia (Central Virginia, specifically Louisa, Hanover, Goochland, Henrico, Richmond, Powhatan, Chesterfield, Fluvanna County or Surrounding Areas)
• Must possess reliable transportation and be willing and able to travel up to 50-75% of the time. Mileage is reimbursed per our company expense reimbursement policy
• LPN/RN/BH with current unrestricted Virginia state licensure required. 
• 3 years Clinical Experience (Preferably in Medical-Surgical Nursing, Behavioral Health, Long term Care, etc.)
• 1+ years Managed Care experience.

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

Preferred Qualifications

• Case Management in an integrated model preferred 5 years clinical practice experience

• Effective communication skills, both verbal and written. 

• Bilingual in English/Spanish

Education

• Associate's Degree Required, preferably in a Nursing degree

• Bachelor'