Case Manager, Registered Nurse - Candidate Must Reside In Arizona

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.

Candidate must reside in Arizona for consideration.

Position Summary

The Nurse Case Manager is a full-time teleworker position. You will be responsible for telephonically and/or face to face 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. You will develop 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.

• Using 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 programs and plans.

• Typical office working environment with productivity and quality expectations.

• 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.

• restrictions/limitations. Assessments include the member’s level of work capacity and related

• Using a holistic approach, assesses 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.

• Work requires the ability to perform close inspection of handwritten 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.

• Multitasks, prioritizes and effectively adapts to a fast-paced changing environment.

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

• Demonstrates effective communication skills, both verbal and written.

Required Qualifications

• Must have active, current, and unrestricted RN (registered Nurse) licensure in Arizona or Compact State RN licensure

• Must reside in Arizona

• 2+ years of experience as a RN (Registered Nurse) in a clinical work setting

• 1+ years of experience with MS Office suites applications

• 1+ years of medical terminology experience

• 2+ years of recent experience in maternal-child health nursing

• Must be willing and able to work Monday through Friday, 8:00am to 5:00pm in AZ time zone

Preferred Qualifications

• Experience working with SEN/NAS newborns.

• Experience working with substance use disorder pregnant women.

• Previous health plan case management experience.

Education

• Associates degree required
• BSN preferred

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