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
Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.
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- Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.
- Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.
- Handles reviews of prior claims to address potential impact on current case management and eligibility.
- Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.
- Ensures case management processes follow organization and regulatory requirements.
- Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.
- Coaches and trains junior colleagues in techniques, processes, and responsibilities.
Must reside in the Tampa area (Manatee, Highlands, Hardee, Hillsborough, Polk Counties)
Minimum 2 years of clinical experience
Minimum 2 years of experience working in case management
Willing and able to travel up to 20% of their time to meet members face to face throughout the Tampa and the surrounding areas
Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policyPreferred Qualifications
Bilingual/Spanish Preferred
Preferred experience with behavioral health conditions
Managed Care experience
Education
Active and unrestricted Registered Nurse licensure in Florida
BSN preferred Anticipated Weekly Hours
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.