Case Manager Registered Nurse - Field – Must reside in Richmond Virginia and Surrounding Areas

CVS Health • Fredericksburg, VA

2d • Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This Case Manager RN position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Richmond VA or Surrounding Areas. The requirements is for candidates to hold a Virginia RN/BH Licensure, and to travel up to 70% of the time to meet with members face to face. Nurse Case Manager is responsible for 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 meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Requirements

• RN/BH with current unrestricted Virginia state licensure required.
• 3 years clinical experience (med surg, behavioral health).
• 2+ years Managed Care experience.
• Must reside in Richmond VA or Surrounding Areas.
• Must possess reliable transportation and be willing and able to travel up to 70% of the time to meet with members face to face. Mileage is reimbursed per our company expense reimbursement policy.
• Valid Virginia Driver's License.
• Associates Degree in Nursing required.
• RN/BH with VA current unrestricted Virginia state licensure required.

Nice To Haves

• Case Management in an integrated model preferred Bilingual preferred.
• 5 years clinical practice experience.
• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
• Proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.

Responsibilities

• 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
• 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
• assess the need for a referral to clinical resources for assistance in determining functionality
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management
• Utilizes case management processes in compliance with regulatory and company policies and procedures
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree