Case Manager, Registered Nurse - Field, CVS Health

CVS Health

Location:
United States, Hamilton, Clermont, or Butler County

Category:
Nursing

Contract Type:
Employment contract

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

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.

Job Responsibility:

Telephonically and/or face to face 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
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
Services strategies policies and programs are comprised of network management and clinical coverage policies
Our 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
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues
Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility
Assessments include the member’s level of work capacity and related restrictions/limitations
Using a holistic approach assess the need for a referral to clinical resources for assistance in g functionality
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management
Utilizes case management processes in compliance with regulatory and company policies and procedures
Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Requirements:

Must have active and unrestricted Registered Nurse (RN) licensure in the state of Ohio or a Compact license
2 years of RN experience
Must be willing and able to travel 50-75% of the time in Hamilton, Clermont, or Butler County. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy

Nice to have:

Home Health experience
Computer Skills (Microsoft office such as: Word, Excel, and outlook)
Bachelor of Science in Nursing

What we offer:

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

Additional Information:

Job Posted:
May 14, 2025

Expiration:
May 16, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Case Manager, Registered Nurse - Field