Registered Nurse Case Management Coordinator – Field
| Company | CVS Health |
|---|---|
| Location | O’Fallon, IL, USA, Swansea, IL, USA |
| Salary | $66575 – $142576 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level |
Requirements
- Minimum 2 years of experience in behavioral health, social services or human services field
- Minimum 2 years of case management experience
- Unrestricted Illinois RN License required
- Must reside in St. Clair County IL (Applicable Zip Codes: 62059, 62060, 62201, 62203, 62204, 62205, 62206, 62207, 62208, 62220, 62221, 62223, 62225, 62226, 62232, 62234, 62236)
- Must possess reliable transportation and be willing and able to travel up to 50-75% of the time to meet members face to face in St Clair County, IL and surrounding areas.
Responsibilities
- Conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Preferred Qualifications
- Discharge planning experience preferred
- Managed Care experience preferred
- Microsoft Office experience preferred