Case Manager RN
Work At Home-Pennsylvania
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 a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states.
Normal Working Hours: Monday-Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 9:00pm EST. There is a late shift rotation until 9:00pm EST and holiday on-call as needed.
There is no travel expected with this position.
The RN Case 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.
RN Case Manager:
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.
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 consider 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 …
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Fully remote Fully remote position
Benefits/PerksCVS store discount Development courses Disability benefits Discount Programs Education assistance Employee stock purchase plan Flexible hours Full range of medical, dental, and vision benefits Full-time Fully-paid term life insurance Fully remote Fully remote position Life Insurance Medical, dental, and vision benefits Paid holidays Paid Time Off Term Life Insurance Vision Benefits Well-being programs
SkillsCase Management Clinical Judgment Clinical Practice Compliance Data Review Excel Health care Holistic approach Integration Interviewing MS Office Organization Outlook Policies and procedures RN RN licensure Telephonic assessment
Experience3 years
Education Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9