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CVS Health Case Manager RN in Chicago, Illinois

Job Description

Prefers candidates residing in Cook County, IL.Utilizes advanced clinical judgement and critical thinkingskills to facilitate appropriate member physical health andbehavioral healthcare through assessment and careplanning, direct provider coordination/collaboration, andcoordination of psychosocial wraparound services topromote effective utilization resources and optimal, cost effective outcomes.Assessment of Members: Through the use of clinical toolsand information/data review, conducts comprehensiveassessments of referred member’s needs/eligibility anddetermines approach to case resolution and/or meetingneeds by evaluating member’s benefit plan and availableinternal and external programs/services. Applies clinicaljudgment to the incorporation of strategies designed toreduce risk factors and address complex clinical indicatorswhich impact care planning and resolution of memberissues. Using advanced clinical skills, performs crisisintervention with members experiencing a behavioral healthor medical crisis and refers them to the appropriate clinicalproviders for thorough assessment and treatment, asclinically indicated. Provides crisis follow up to members tohelp ensure they are receiving the appropriatetreatment/services. Enhancement of MedicalAppropriateness and Quality of Care: Application and/orinterpretation of applicable criteria and clinical guidelines,standardized case management plans, policies,procedures, and regulatory standards while assessingbenefits and/or member’s needs to ensure appropriateadministration of benefits. Using holistic approach consultswith supervisors, Medical Directors and/or other programsto overcome barriers to meeting goals and objectives;presents cases at case conferences to obtainmultidisciplinary view in order to achieve optimal outcomes.Identifies and escalates quality of care issues throughestablished channels. Ability to speak to medical andbehavioral health professionals to influence appropriatemember care. -Utilizes influencing/motivational interviewingskills to ensure maximum member engagement andpromotes lifestyle/behavior changes to achieve optimumlevel of health. Provides coaching, information and supportto empower the member to make ongoing independentmedical and/or healthy lifestyle choices. Helps memberactively and knowledgably participate with their provider inhealthcare decision-making -Analyzes all utilization, selfreport and clinical data available to consolidate informationand begin to identify comprehensive member needs.Monitoring, Evaluation and Documentation of Care: Incollaboration with the member and their care teamdevelops and monitors established plans of care to meetthe member’s goals Utilizes case management and qualitymanagement processes in compliance with regulatory andaccreditation guidelines and company policies andprocedures.

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

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

Minimum of 3 years of direct clinical practice experience (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)-Must possess unencumbered RN license in the state of Illinois.-Willing and able to travel up to 10% of their time using their own vehicle for onsite team meetings within the state of IL.

Preferred Qualifications

-Managed care/utilization review experience preferred-Case management and discharge planning experiencepreferred


Minimum of a Associate degree 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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