Case Manager, Registered Nurse – Oncology Experience Required

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🕒 2 days ago

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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.

📋 Description

• Work intensely as a telephonic case manager with patients and their care teams for fully and/or self-insured clients • Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards • Assess benefits and member needs to ensure appropriate administration of benefits • Apply clinical judgment and strategies to reduce risk factors and barriers and address complex health and social indicators • Conduct holistic assessments covering co-morbidities and multiple diagnoses affecting functionality • Consult with supervisors, clinical colleagues, Medical Directors, and other programs to overcome barriers and meet goals • Present cases at case conferences for multidisciplinary claim-management focus • Use case management processes in compliance with regulatory and company policies and procedures • Use motivational interviewing to maximize member engagement and identify health status and needs • Identify and appropriately escalate member needs according to guidelines and protocols • Actively reach out to members to collaborate on and guide their care • Perform medical necessity reviews

🎯 Requirements

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting • Active multistate Nurse Licensure Compact license if residing in a compact state, or individual state-specific RN licenses for each supported state if residing in a non-compact state • 1+ years’ experience documenting electronically using a keyboard • 1+ years’ current or previous experience in Oncology • Diploma or Associates Degree in Nursing required • Ability to support members across multiple states

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Virtual training