Case Manager- RN
About the position The RN Case Manager role at CVS Health is a vital position within Aetna One Advocacy (A1A), focusing on delivering high-quality, human-centric health care. This role requires a commitment to enhancing the health care experience for members through proactive case management. The position involves both telephonic and face-to-face interactions with members to assess their medical needs, plan appropriate interventions, and coordinate care effectively. The RN Case Manager will utilize clinical tools and data to evaluate member needs, ensuring a smooth transition to Aetna programs and plans. This role emphasizes a holistic approach to care, considering various health and social factors that may impact a member's well-being. The Case Manager will be responsible for developing proactive strategies to address health issues, utilizing clinical judgment to reduce risk factors, and facilitating member engagement through effective communication. The position requires collaboration with multidisciplinary teams to present cases and overcome barriers to achieving health goals. Compliance with regulatory and company policies is essential, as is the ability to conduct thorough assessments that consider co-morbid conditions and the member's overall functionality. This position is based in High Point, North Carolina, with an initial training period of approximately three months in the office. After training, the role transitions to a work-from-home model, with occasional in-office workdays scheduled in advance. The RN Case Manager will work normal hours from 8 am to 4:30 pm EST, with some flexibility for later shifts on a team rotation. Importantly, there are no weekend shifts required for this role.
Responsibilities
- Telephonically and/or face-to-face assess, plan, implement, and coordinate all case management activities with members.
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- Develop a proactive course of action to enhance short and long-term outcomes for members.
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- Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
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- Apply clinical judgment to incorporate strategies that reduce risk factors and address complex health and social indicators.
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- Review prior claims to assess their impact on current case management and eligibility.
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- Assess the member's level of work capacity and related restrictions/limitations.
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- Utilize a holistic approach to assess the need for referrals to clinical resources for functionality determination.
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- Consult with supervisors and others to overcome barriers in meeting goals and objectives.
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- Present cases at case conferences for multidisciplinary focus to benefit overall claim management.
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- Utilize case management processes in compliance with regulatory and company policies and procedures.
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- Engage members through effective interviewing skills to discern their health status and needs.
Requirements
- Registered Nurse with an unrestricted license in their state of residence, with multi-state/compact privileges.
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- 3+ years of clinical practice experience as an RN.
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- Willingness to obtain all 50 state licenses upon hire.
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- Must live within a commutable distance of High Point, North Carolina (typically within 45 minutes maximum).
Nice-to-haves
- Experience in Case Management within an integrated model.
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- Certified Case Manager (CCM) certification.
Benefits
- Full range of medical, dental, and vision benefits.
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- 401(k) retirement savings plan.
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- Employee Stock Purchase Plan for eligible employees.
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- Fully-paid term life insurance plan for eligible employees.
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- Short-term and long-term disability benefits.
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- Numerous well-being programs and education assistance.
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- Free development courses.
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- CVS store discount and discount programs with participating partners.
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- Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the year.
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