Case Manager, Registered Nurse

Job not on LinkedIn

🔥 14 hours ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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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

• Coordinate and facilitate comprehensive care for individuals • Assess member needs and develop personalized care plans • Coordinate services across healthcare providers • Advocate for patients and ensure effective communication and resource utilization • Serve as liaison among members, families, employers, providers, insurance companies, and healthcare personnel • Coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care • Conduct telephonic and in-person interactions, including possible home, worksite, or physician-office visits • Assess medical and/or vocational status and facilitate condition management, wellness, medical outcomes, return to work, and benefits eligibility • Communicate with members and stakeholders, including medical providers, attorneys, employers, and insurance carriers • Prepare required case-work documentation • Consult with internal multidisciplinary teams • Contact treating physicians or specialists regarding care and treatment • Provide education and prevention information • Apply applicable laws, regulations, insurer instructions, and referral-source requirements • Evaluate needs and benefit-plan eligibility using clinical tools and data • Monitor member progress toward desired outcomes • Develop proactive actions to improve short- and long-term outcomes and overall wellness

🎯 Requirements

• Candidate preferably resides in Michigan • Active and unrestricted RN licensure in Michigan • 3+ years of clinical practical experience preferred, including diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or home health with Medicare members • 2+ years of case management, discharge planning and/or home health care coordination experience • Proficiency with Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications • Strong computer skills, including navigating multiple systems and keyboarding • Working knowledge of medical terminology and digital literacy • Ability to work in a fast-paced, high-volume environment • Time management and prioritization skills • Ability to handle sensitive information ethically and responsibly • Associate's Degree in Nursing (REQUIRED) • Active and unrestricted Compact Registered Nurse (RN) Licensure in the state of residence (MI) • Direct/hardwired internet connection within 7 feet of the modem/router, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted • Quiet, secure, private, designated home workspace compliant with CVS Health and HIPAA guidelines • Ability to work within the state and city where currently residing • Ability to set up and use multiple monitors and navigate multiple applications • Ability to use digital communication tools, Microsoft Office 365 or Google Workspace • Ability to access secure systems such as VPN and EHR portals and follow security practices • Ability to troubleshoot common technical issues • Openness to learning new skills • Preferred: national professional certification (CRC, CDMS, CRRN, COHN, or CCM) • Preferred: bilingual Spanish • Bachelor's Degree in Nursing (PREFERRED)

🏖️ Benefits

• Comprehensive medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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