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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. This is a work from home flexible position with 25-50% travel requirements within 50 miles in or around Mercer County, New Jersey (50-mile radius from applicant's home). Standard working hours Monday – Friday 8-5 pm EST. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. 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 dually eligible members to change lives in markets across the country. Our Integrated Care Management (ICM) Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. The ICM care manager develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
Job Responsibility:
Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
Utilizes case management processes in compliance with regulatory and company policies and procedures
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation
Requirements:
Minimum 3+ years of clinical practice experience
Must have active and unrestricted RN licensure in the state of NJ
Willing and able to travel 25-50% of their time using your own vehicle to meet members face to face in the Mercer County, New Jersey area
Reliable transportation required
Must reside within 50 miles of Mercer County, New Jersey (50-mile radius from applicant's home)
Associate's Degree or Diploma RN required
Nice to have:
Certified Case Manager is preferred
Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Effective computer skills including navigating multiple systems and keyboarding
Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
Bilingual preferred (English / Spanish)
Bachelor’s Degree in Nursing (Preferred)
What we offer:
Mileage is reimbursed per our company expense reimbursement policy
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching