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. Summary:
The Transition of Care Service Coordinator is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in an inpatient admission. The Transition of Care (TOC) RN ensures the member experiences a seamless transition to their next care setting.Position Responsibilities:
• Responsible for telephonic and/or face to face assessing, planning, implementing, and coordinating all care management activities with members to evaluate the medical and behavioral health needs 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.
• Using clinical tools and information/data review, conducts comprehensive assessments of member's needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.
• Applies clinical judgement to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Complete assessments taking into account information from various sources to address conditions including co-morbid and multiple diagnosis that impact functionality and include the member's restrictions/limitations.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Attends and participates in case rounds, including utilization management rounds for behavioral health and physical health to obtain multidisciplinary view to achieve optimal outcomes.
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• Collaborates with the member, and inpatient facilities to coordinate discharge needs including ensuring post discharge needs are met.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
• Utilizes care management processes in compliance with regulatory and company policies and procedures.
• Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and throughout subsequent care continuum.
• Facilitates clinical hand offs during transitions of care.
Reports to: Manager, Clinical Health ServicesRequired Qualifications:
• Active current unrestricted RN licensure in the state of Florida with hospital discharge planning experience
• 3-5 years clinical practice experience with discharge planning experience, e.g. hospital setting
• Experience managing complex medical & behavioral health conditions
• Must reside in South Florida
• Willing and able to travel up to 20% of their time to meet members face to face in the Miami Dade and Monroe Counties
• Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policyPreferred Qualifications:
• Behavioral Health Experience
• Case management in an integrated model
• Experience providing care to the Medicaid population
• Bilingual in SpanishLicense/Credential Requirements:
• Active current unrestricted RN licensure in the state of FloridaEducation:
- Associates degree or Diploma in Nursing required
- BSN preferred
40Time Type
Full timePay Range
The typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- 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.
Perks and Benefits
Health and Wellness
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- HSA
- HSA With Employer Contribution
- Pet Insurance
- Mental Health Benefits
Parental Benefits
- Fertility Benefits
- Adoption Assistance Program
- Family Support Resources
Work Flexibility
- Flexible Work Hours
- Remote Work Opportunities
- Hybrid Work Opportunities
Office Life and Perks
Vacation and Time Off
- Paid Vacation
- Paid Holidays
- Personal/Sick Days
Financial and Retirement
- 401(K) With Company Matching
Professional Development
- Tuition Reimbursement
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Diversity, Equity, and Inclusion Program