Nurse Case Manager RN
Company: CVS Health
Posted on: November 18, 2021
Help us elevate our patient care to a whole new level! Join our
Community Care team as an industry leader in serving our members by
utilizing best-in-class operating and clinical models. You can have
life-changing impact on our Community Care members. With
compassionate attention and excellent communication, we collaborate
with members, providers, and community organizations to address the
full continuum of our members' health care and social determinant
needs. Join us in this exciting opportunity as we grow and expand
to change lives in new markets across the country.
Facilitate the delivery of appropriate benefits and/or healthcare
information which determines eligibility for benefits while
promoting wellness activities. Develops, implements and supports
Health Strategies, tactics, policies and programs that ensure the
delivery of benefits and to establish overall member wellness and
successful and timely return to work. Services and strategies,
policies and programs are comprised of network management, clinical
coverage, and policies.
Community Care Case Manager use a collaborative process of
assessment, planning, facilitation, care coordination, evaluation,
and advocacy for options and services to meet an individual's and
family's comprehensive health needs through communication and
available resources to promote quality, cost effective
Acts as a liaison with member/client /family, employer,
provider(s), insurance companies, and healthcare personnel as
Implements and coordinates all case management activities relating
to catastrophic cases and chronically ill members/clients across
the continuum of care that can include consultant referrals, home
care visits, the use of community resources, and alternative levels
Interacts with members/clients telephonically or in person. May be
required to meet with members/clients in their homes, worksites, or
physician's office to provide ongoing case management services.
Assesses and analyzes injured, acute, or chronically ill
members/clients medical and/or vocational status; develops a plan
of care to facilitate the member/client's appropriate condition
management to optimize wellness and medical outcomes, aid timely
return to work or optimal functioning, and determination of
eligibility for benefits as appropriate. (*)
Communicates with member/client and other stakeholders as
appropriate (e.g., medical providers, attorneys, employers and
insurance carriers) telephonically or in person. (*)
Prepares all required documentation of case work activities as
Interacts and consults with internal multidisciplinary team as
indicated to help member/client maximize best health outcomes.
May make outreach to treating physician or specialists concerning
course of care and treatment as appropriate. (*)
Provides educational and prevention information for best medical
Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required
by individual insurance carriers and referral sources. (*)
Testifies as required to substantiate any relevant case work or
Conducts an evaluation of members/clients' needs and benefit plan
eligibility and facilitates integrative functions using clinical
tools and information/data.
Utilizes case management processes in compliance with regulatory
and company policies and procedures.
Facilitates appropriate condition management, optimize overall
wellness and medical outcomes, appropriate and timely return to
baseline, and optimal function or return to work.
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/client's overall wellness
Monitors member/client progress toward desired outcomes through
assessment and evaluation.
Minimum 3-5 years clinical practical experience
Minimum 2-3 years CM, discharge planning and/or home health care
Registered Nurse with active state license in good standing within
the region where job duties are performed is required.
Ability to travel within a designated geographic area for in-person
case management activities as directed by Leadership and/or as
business needs arise
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal
Ability to work independently (may require working from home).
Proficiency with standard corporate software applications,
including MS Word, Excel, Outlook and PowerPoint, as well as some
special proprietary applications.
Effective computer skills including navigating multiple systems and
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from
If you are 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 within the first 30 days
of your employment. For the two COVID-19 shot regimen, you will be
required to provide proof of your second COVID-19 shot within the
first 60 days of your employment. Failure to provide timely proof
of your COVID-19 vaccination status will result in the termination
of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical
condition, pregnancy, or religious belief, you will be required to
apply for a reasonable accommodation within the first 30 days of
your employment in order to remain employed with CVS Health. As a
part of this process, you will be required to provide information
or documentation about the reason you cannot be vaccinated. If your
request for an accommodation is not approved, then your employment
may be terminated.
Certified Case Manager is preferred.
Additional national professional certification (CRC, CDMS, CRRN,
COHN, or CCM) is preferred, but not required
Associates degree with equivalent experience, applicant would be
required to obtain a bachelor's degree within 3-5 years as part of
role development, state licensing laws may apply
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, Newark , Nurse Case Manager RN, Executive , Newark, New Jersey
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