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CVS Health Case Manager RN in Arizona

Job Description

Schedule: Monday-Friday 8am-5pm Arizona time. No weekends or holidays!Candidates who live in State of Arizona may be required to travel up to 10% of the time. Travel will be also be required to the Phoenix, AZ office up to once a month for AZ residents.Nurse Case Manager is a full time teleworker position that requires some travel. This position is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. 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 overall wellness through integration. Services, strategies, policies and programs are comprised of network management and clinical coverage policies.At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona. Fundamental Components• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which 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 a referral to clinical resources for assistance in determining functionality. • Consults with management and others in overcoming barriers in meeting goals and objectives, presents cases at care conferences for multidisciplinary focus to benefit overall management. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.• Typical office working environment with productivity and quality expectations.• Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.• Multitasks, prioritizes and effectively adapts to a fast-paced changing environment.• Demonstrates proficiency with computer skills which includes navigating multiple systems and keyboarding.• Demonstrates effective communication skills, both verbal and written.Demonstrates critical thinking skills for physical and behavior conditions

Pay Range

The typical pay range for this role is:

Minimum: 58,760

Maximum: 125,840

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

-Must have an active and unrestricted Arizona RN or Compact RN license-5+ years of clinical experience, with at least 3 of those years working with the adult population-Reliable transportation required-Mileage is reimbursed per our company expense reimbursement policy

Preferred Qualifications

-BSN preferred-Have worked with behavioral health conditions-3+ years field experience with care management (Home Health, hospice, LTC etc)-Candidate reside in Arizona state (preferred but not mandatory)-Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.


-Associate's degree minimum required -BSN preferred

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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