Care Manager - RN

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

This Case Manager RN position is 100% remote and the employee can live in any state.

Normal Working Hours: Monday through Friday 8:00am through 4:30pm in time zone of residence with an occasional late shift rotation per the needs of the business 10:30am-7pm EST (1-2 times per quarter). Typical training hours are Monday-Friday 8-4:30 EST.

Nurse Care Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

-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 overall wellness through integration.

- Services strategies policies and programs are comprised of network management and clinical coverage policies.

- Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

- Reviews prior claims to address potential impact on current case management and eligibility.

- Assessments include the member’s level of work capacity and related restrictions/limitations.

- Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

- Consults with supervisor and others in overcoming barriers in …