Case Manager - Registered Nurse

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• 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 of care.
• 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 appropriate.
• 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 outcomes.
• 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.
• 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 through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure and live in compact state
• 3+ years clinical practical experience with preference in the following areas: diabetes, Congestive Heart Failure ( CHF), Chronic Kidney Disease ( CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members
• 2+ years case management, discharge planning and/or home health care coordination experience
• 2+ years of experience with Microsoft Word, Excel, and Outlook

• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Certified Case Manager
• National professional certification (CRC, CDMS, CRRN, COHN, or CCM)
• Efficient and effective computer skills including navigating multiple systems and keyboarding
• Willing and able to obtain multi state Registered Nurse (RN) licenses (If needed, company will provide)
• Candidates that live in the Southeast Region (States Included but Not Limited To - FL, GA, AL, MS, NC, SC, TN)

• Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

• Active and unrestricted Compact Registered Nurse (RN) licensure and live in compact state

• 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.