Case Manager, Registered Nurse

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🔥 il y a 8 heures

🦌 Connecticut, Maine, +3 états de plus – Distant

🦌 Connecticut – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote ⚓ Rhode Island – Remote 🍁 Vermont – Remote

💵 $66 575 - $142 576 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

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CVS Health

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1963

⚕️ Assurance santé

🛒 Commerce de détail

🧘 Bien-être

Healthcare Insurance • Retail • Wellness

CVS Health est une entreprise américaine de premier plan dans le domaine de la santé, dédiée à l'amélioration de l'accès et de l'accessibilité financière des soins de santé. L'entreprise s'appuie sur une approche globale qui comprend les services de santé, l'assurance santé et la gestion des prestations pharmaceutiques. À travers ses filiales, telles qu'Aetna et CVS Caremark, CVS Health propose une gamme de services qui favorisent le bien-être, la gestion des maladies chroniques et une couverture abordable des médicaments prescrits. CVS Health exploite des pharmacies de proximité, fournit des services de pharmacie par correspondance et gère des programmes de médicaments spécialisés, visant à rendre les soins de santé pratiques et accessibles à tous. Animée par une mission de connecter les individus aux services de soins essentiels, CVS Health s'engage à favoriser des communautés en meilleure santé et à soutenir le bien-être de toutes les personnes.

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 • 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.

🎯 Exigences

• Active and unrestricted Registered Nurse License in East Coast States • Minimum 3+ years clinical practical experience with Medicare members (specifically diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac members) • Minimum 2+ years CM, discharge planning and/or home health care coordination experience • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills. • Ability to work independently

🏖️ Avantages

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility