Clinical Case Manager, RN Field - Bilingual, CVS Health

CVS Health

Location:
United States, Orlando, FL

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

54095.00 - 116760.00 USD / Year

Save Job

Job offer has expired

Job Description:

The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Job Responsibility:

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

Requirements:

Must reside in Orange, Seminole, Brevard and Osceola Counties, FL or a surrounding county
Active current unrestricted RN licensure in the state of Florida
3+ years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Willing and able to travel 10-20% of their time to meet members face to face in the Miami Dade County and surrounding areas. Reliable transportation required
2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications
and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Nice to have:

Chronic disease management preferred (cancer, diabetes, hypertension, chronic kidney disease, serious mental illness, and/or HIV aids)
Case management in an integrated model preferred
Managed care experience
Discharge planning experience
Experience providing care to the Medicaid population
Bilingual in Creole and/or Spanish

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:
August 09, 2025

Expiration:
August 18, 2025

Employment Type:

Fulltime

View All Jobs In This Company

Job Link Share:

Clinical Case Manager, RN Field - Bilingual