CVS Health Case Manager RN in WORK FROM HOME, Kentucky
Schedule: Monday-Friday standard business hours, 1 late night shift to 11:30am-8pm EST.Possibility for a Saturday shift in the future on rotational basis if needed. No holidays. Currently remote role.Must reside within a 60 miles radius of an Aetna office as this is an in-office & work from the home flexible position for candidates located near the High Point, NC, Denver, CO, or Chantilly, VA offices once COVID restrictions are lifted. Up to 5 percent travel.This position is also a full-time telework opportunity open to candidates who hold a compact RN license in one of the following states: AL. AZ, AR, CO, DE, FL, GA, ID, IA, LA, KS, KY, MD, ME, MS, MN, MO, NM, NE, NC, NH, ND, RI, SC, SD, TN, TX, UT, VA, WV, and WI.The Nurse Case Manager is responsible for telephonically 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.Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators that 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 claim to address the 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 supervisor and others in overcoming barriers in meeting goals and objectives presents cases at case conferences for the multidisciplinary focus to benefit overall claim 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
3+ years clinical practice experience required Strong computer and typing skills required 3+ years of Case Management
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.
Renal Experience PreferredBSN with current unrestricted state licensure required
ASN- RN with current unrestricted state licensure requiredBSN 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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