RN Case Manager (Northern Region) CARDINAL
Company: CVS Health
Posted on: June 25, 2022
Qualifying candidates may be eligible for a sign on bonus of up
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
- 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
- Using a holistic approach assess the need for a referral to
clinical resources for assistance in determining
- 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
- 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
- Work requires the ability to perform close inspection of hand
written and computer-generated documents as well as a PC
- 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.
- 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-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
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.
- Case management experience in an integrated model is
- Case Management (CCM) Certification is preferred.
- BSN degree is preferred.
Diploma RN or Associate degree in Nursing is acceptable.
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
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
Keywords: CVS Health, Leesburg , RN Case Manager (Northern Region) CARDINAL, Healthcare , Leesburg, Virginia
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