Case Manager RN, Compact License

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 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

• Act as a liaison with members, clients, families, employers, providers, insurance companies, and healthcare personnel • Coordinate case management activities for catastrophic cases and chronically ill members/clients across the continuum of care • Interact with members/clients telephonically or in person, including potentially in homes, work sites, or physician offices • Assess and analyze medical and/or vocational status and develop plans of care • Communicate with members/clients 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 laws, regulations, insurance-carrier instructions, and referral-source requirements • Testify as required to substantiate case work or reports • Evaluate member/client needs and benefit plan eligibility using clinical tools and data • Follow care management processes and regulatory and company policies • Facilitate condition management, wellness, medical outcomes, return to baseline, optimal function, or return to work • Develop proactive actions to improve short- and long-term outcomes and overall wellness • Monitor member/client progress toward desired outcomes through assessment and evaluation

🎯 Requirements

• Candidate must reside in New Jersey • Active and unrestricted New Jersey Registered Nurse (RN) Compact License required • 3+ years clinical practice experience • 2+ years case management, discharge planning, and/or home health care coordination experience • Ability to occasionally travel up to 10% within a designated geographic area for in-person case management activities • 2+ years proficiency with Microsoft Word, Teams, Excel, Outlook, and PowerPoint • Experience working with Medicare members with diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), post-acute care, hospice, palliative care, and/or cardiac preferred • Managed care experience preferred • Willing and able to obtain additional state RN licenses if needed preferred • Excellent analytical and problem-solving skills • Effective communication, organizational, and interpersonal skills • Ability to work independently, remotely, and field based • Efficient and effective computer skills, including navigating multiple systems and keyboarding • Associate's Degree in Nursing required • Bachelor's Degree in Nursing preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility