CVS Health Case Manager RN in Hartford, Connecticut
Working hours will be Monday -Friday 8am-5pm. No weekendsHolidays may be required on call. May require less than 10% travel to meet with customers or for auditing. Candidates can apply from any state. This position will be working from home and it's preferredthat the employee is located in Central or Eastern timezones. Once CVOID restrictions are lifted, this role maybecome office based. Nurse Case Manager 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 issuespresented to enhance the short and long-term outcomesas well as opportunities to enhance a member’s overallwellness through integration.-Services strategies policies and programs are comprisedof network management and clinical coverage policies.-Through the use of clinical tools and information/datareview, conducts an evaluation of member's needs andbenefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.-Applies clinical judgment to the incorporation of strategiesdesigned to reduce risk factors and barriers and addresscomplex health and social indicators which impact careplanning and resolution of member issues.-Assessments take into account information from varioussources to address all conditions including co-morbid andmultiple diagnoses that impact functionality.-Reviews prior claims to address potential impact oncurrent case management and eligibility.-Assessments include the member’s level of work capacityand related restrictions/limitations.-Using a holistic approach assess the need for a referral toclinical resources for assistance in determiningfunctionality.-Consults with supervisor and others in overcomingbarriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefitoverall claim management.-Utilizes case management processes in compliance withregulatory and company policies and procedures.-Utilizes interviewing skills to ensure maximum memberengagement and discern their health status and healthneeds based on key questions and conversation.
-RN unrestricted license in state of residence-3 years minimum of acute care experience-Willingness to obtain additional state licenses upon hire
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
CCM preferred but not required
Associate's Degree or higherBSN preferred
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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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