Case 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: 8:00am through 4:30pm in time zone of residence with a 10:30am-7:00pm EST rotation approximately once per Quarter. 

 No travel is expected with this position. 

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. 

The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. 

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills. 

The responsibilities of this Case Manager RN position are to: 

-Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.  

-Conduct comprehensive clinical assessments.  

-Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services.  

-Advocate for patients to the full extent of existing health care coverage. 

-Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency. 

-Identify and escalate quality of care issues through established channels. 

-Provide an expected …