Experienced Full Stack Case Manager RN – Telehealth and Community Outreach Specialist for Medicaid and Managed Care Services

About Us

CVS Health is a leader in the healthcare industry, dedicated to delivering innovative and personalized solutions to improve the lives of our patients and communities. Our mission is to bring our heart to every moment of your health, and we're committed to making a positive impact on the world around us. At CVS Health, we believe that every individual deserves access to high-quality healthcare, and we're working tirelessly to make that a reality.

Our Culture

Our culture is built on a set of core values that guide everything we do. We're passionate about putting our heart into caring for our colleagues and our communities, and we're committed to creating a workplace that's inclusive, supportive, and empowering. Our Heart At Work Behaviors support our purpose and drive our commitment to delivering exceptional care and service to our patients and customers.

About the Role

We're seeking an experienced and compassionate Registered Nurse to join our Case Management team as a Telehealth and Community Outreach Specialist for Medicaid and Managed Care Services. This is a full-time remote position that requires 50-75% travel in Hamilton County or Clermont County, Ohio. As a Case Manager RN, you'll play a critical role in assessing, planning, implementing, and coordinating care for our members to evaluate their medical needs and facilitate their overall wellness.

Key Responsibilities

• Assess, plan, implement, and coordinate all case management activities with members to evaluate their medical needs and facilitate their overall wellness.
• Develop proactive courses of action to address issues presented to enhance short and long-term outcomes and opportunities to enhance a member's overall wellness through integration.
• Utilize clinical tools and information/data review to conduct evaluations of member needs and benefit plan eligibility and facilitate integrative functions as well as smooth transitions to Aetna programs and plans.
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators that 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 referrals to clinical resources for assistance in g functionality.
• Consult 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.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Utilize interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Requirements

To be successful in this role, you'll need to have:

• Active and unrestricted RN licensure in the state of Ohio or a Compact license.
• 3+ years of RN experience.
• Willingness and ability to travel 50-75% of the time in Hamilton or Clermont County. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

We're looking for candidates with:

• Home Health experience.
• Preference for those that reside in Hamilton or Clermont County.

Education

You'll need to have an Associate's Degree or higher.

Compensation and Benefits

We offer a competitive salary range of $54,095.60 - $116,760.80, depending on experience, education, and other relevant factors. In addition to your compensation, you'll enjoy a range of benefits, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs.
• Education assistance.
• Free development courses.
• CVS store discount.
• Discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay.
• Paid holidays throughout the calendar year.

Career Growth and Development

We're committed to helping you grow and develop in your career. As a Case Manager RN, you'll have opportunities to:

• Develop your clinical skills and knowledge.
• Take on new challenges and responsibilities.
• Collaborate with a talented team of healthcare professionals.
• Make a meaningful impact on the lives of our patients and communities.

Work Environment and Culture

We're proud of our inclusive and supportive work environment, which is built on our Heart At Work Behaviors. As a Case Manager RN, you'll be part of a team that's passionate about delivering exceptional care and service to our patients and customers. We're committed to creating a workplace that's empowering, supportive, and fun.

How to Apply

If you're a motivated and compassionate Registered Nurse who is passionate about delivering exceptional care and service, we encourage you to apply for this exciting opportunity. Please visit our website to learn more and submit your application.

Equal Employment Opportunity

CVS Health is an equal opportunity employer and welcomes applications from diverse candidates. We're committed to creating a workplace that's inclusive, supportive, and empowering for all employees. If you have a disability or need a reasonable accommodation to apply for this role, please contact us at [email protected] or 7-1-1 to utilize Telecommunications Relay Services (TRS).