Case Manager, Registered Nurse

Job not on LinkedIn

20 hours ago

🌽 Illinois – Remote

Although this job is listed in Illinois, this company may be open to hiring remote in other states.

💵 $66.6k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients 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 members/clients telephonically or in person • May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s 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 member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) 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 member/client maximize best health outcomes • May make outreach to 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 individual insurance carriers and referral sources • Conducts an evaluation of members/clients’ needs and benefit plan eligibility 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 member’s/client’s overall wellness through integration • Monitors member/client progress toward desired outcomes through assessment and evaluation

🎯 Requirements

• Must live in IL - Will be required to do field visits if needed • Minimum 3-5 years clinical practical experience preference required • Minimum 2-3 years CM, discharge planning and/or home health care coordination experience • 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 • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills • Ability to work independently • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications • Efficient and Effective computer skills including navigating multiple systems and keyboarding

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs including wellness screenings, tobacco cessation, and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access