Case Manager RN – Cst
| Company | CVS Health |
|---|---|
| Location | North Dakota, USA, Iowa, USA, South Dakota, USA, Colorado, USA, Nebraska, USA |
| Salary | $54095 – $116760 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level, Senior |
Requirements
- Must possess active and unrestricted compact RN licensure in state of residence. Licensure must be compact
- Minimum 3+ years clinical practical experience (with preference being diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
- Minimum 2+ years of experience in Case Management, discharge planning and/or home health care coordination experience
- Willing and able to obtain multi-state RN licenses if needed, company will provide
Responsibilities
- Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
- Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
- Prepares all required documentation of case work activities as appropriate.
- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
- Provides educational and prevention information for best medical outcomes.
- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
- Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
- 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/client’s overall wellness through integration.
- Monitors member/client progress toward desired outcomes through assessment and evaluation.
Preferred Qualifications
- Certified Case Manager is preferred
- Additional national professional certification (CRC, CDMS, CRRN, COHN) is preferred, but not required
- Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
- Bilingual preferred
- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
- Efficient and effective computer skills including navigating multiple systems and keyboarding