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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. Job Summary: The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.
Job Responsibility:
Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs
Provides evidence-based disease management education and support to help the member achieve health goals
Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care
Provides care coordination to support a seamless health care experience for the member
Meticulous documentation of care management activity in the member’s electronic health record
Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition
Identifies and connects members with health plan benefits and community resources
Meets regulatory requirements within specified timelines
The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed
Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members
Requirements:
Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually
3+ years of nursing experience
2+ years of case management, discharge planning and/or home healthcare coordination experience
Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED)
Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence
Nice to have:
Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning process
Bilingual skills, especially English-Spanish
Bachelor’s of Science in Nursing (BSN) (PREFERRED)
What we offer:
Medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
CVS Health bonus, commission or short-term incentive program