Case Manager - Registered Nurse - Southeast Region

Job Title: Case Manager - Registered Nurse - Southeast Region

Job Location: Work at Home, Florida, United States

Job Location Type: Remote

Job Contract Type: Full time
Job Seniority Level:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
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 appropriatecondition 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.

Required Qualifications

- Candidates must live in the Southeast Region (States Include- FL, GA, AL, MS, NC, SC, TN, AR, LA)

- Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence

- 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

Preferred Qualifications

- Previous work from home experience in a healthcare related field

- Excellent analytical and problem-solving skills

- Effective communications, organizational, and interpersonal skills

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