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RN Case Manager (Northern Region) CARDINAL

Company: CVS Health
Location: Leesburg
Posted on: May 13, 2022

Job Description:

Qualifying candidates may be eligible for a sign on bonus of up to $5,000.

This is a full time remote teleworker position in Virginia. The Case Manager RN (CM RN) 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. Travel is required; 25-40% of the time, in the Northern Winchester Region.

Fundamental Components:

  • 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.
  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
  • Effective communication skills, both verbal and written.
    Required Qualifications
    • Registered Nurse with current unrestricted Virginia (VA) license or Registered Nurse with current unrestricted VA "multi-state privilege" license
    • Minimum 1+ year of related clinical nursing experience with medically complex members.
    • 5+ years clinical practice experience.
    • Resides in VA; in the Northern Winchester region.
    • Ability to travel with personal vehicle, 25-40% of the time. Must possess reliable transportation, active driver's license, and proof of vehicle insurance.
    • Demonstrated proficiency with personal computer, keyboard, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint
      COVID Requirements

      COVID-19 Vaccination Requirement
      CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

      You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

      Preferred Qualifications
      • Case management experience in an integrated model is preferred.
      • Case Management (CCM) Certification is preferred.
      • BSN degree is preferred.
        Education
        Diploma RN or Associate degree in Nursing is acceptable.

        Business Overview
        At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
        We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Keywords: CVS Health, Leesburg , RN Case Manager (Northern Region) CARDINAL, Executive , Leesburg, Virginia

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