Case Manager RN- Field - Case Management
Company: CVS Health
Location: Irving
Posted on: May 26, 2023
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Job Description:
Case Manager RN- FieldJob Description
Schedule is Monday-Friday, standard business hours. 8am-5pm
Assessment of Members: Through the use of clinical tools and
information/data review, conducts comprehensive assessments of
referred member's needs/eligibility and determines approach to case
resolution and/or meeting needs by evaluating member's benefit plan
and available internal and external programs/services.
* Applies clinical judgment to the incorporation of strategies
designed to reduce risk factors and address complex clinical
indicators which impact care planning and resolution of member
issues.
* Using advanced clinical skills, performs crisis intervention with
members experiencing a behavioral health or medical crisis and
refers them to the appropriate clinical providers for thorough
assessment and treatment, as clinically indicated.
* Provides crisis follow up to members to help ensure they are
receiving the appropriate treatment/services.
Enhancement of Medical Appropriateness and Quality of Care:
* Application and/or interpretation of applicable criteria and
clinical guidelines, standardized case management plans, policies,
procedures, and regulatory standards while assessing benefits
and/or member's needs to ensure appropriate administration of
benefits
* Using holistic approach consults with supervisors, Medical
Directors and/or other programs to overcome barriers to meeting
goals and objectives-- presents cases at case conferences to obtain
multidisciplinary view in order to achieve optimal outcomes -
Identifies and escalates quality of care issues through established
channels
* Ability to speak to medical and behavioral health professionals
to influence appropriate member care.
* Utilizes influencing/motivational interviewing skills to ensure
maximum member engagement and promotes lifestyle/behavior changes
to achieve optimum level of health
* Provides coaching, information and support to empower the member
to make ongoing independent medical and/or healthy life style
choices.
* Helps member actively and knowledgably participate with their
provider in healthcare decision-making
* Analyzes all utilization, self-report and clinical data available
to consolidate information and begin to identify comprehensive
member needs.
Monitoring, Evaluation and Documentation of Care:
* In collaboration with the member and their care team develops and
monitors established plans of care to meet the member's goals
* Utilizes case management and quality management processes in
compliance with regulatory and accreditation guidelines and company
policies and procedures.
* Conduct face to face visits in member homes, provider offices or
facilities to coordinate service needs and transition of care
Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
This pay range represents the base hourly rate or base annual
full-time salary for all positions in the job grade within which
this position falls. The actual base salary offer will depend on a
variety of factors including experience, education, geography and
other relevant factors. This position is eligible for a CVS Health
bonus, commission or short-term incentive program in addition to
the base pay range listed above.
In addition to your compensation, enjoy the rewards of an
organization that puts our heart into caring for our colleagues and
our communities. The Company offers a full range of medical,
dental, and vision benefits. Eligible employees may enroll in the
Company's 401(k) retirement savings plan, and an Employee Stock
Purchase Plan is also available for eligible employees. The Company
provides a fully-paid term life insurance plan to eligible
employees, and short-term and long term disability benefits. CVS
Health also offers numerous well-being programs, education
assistance, free development courses, a CVS store discount, and
discount programs with participating partners. As for time off,
Company employees enjoy Paid Time Off (PTO) or vacation pay, as
well as paid holidays throughout the calendar year. Number of paid
holidays, sick time and other time off are provided consistent with
relevant state law and Company policies.
For more detailed information on available benefits, please
visit
jobs.CVSHealth.com/benefits
Required Qualifications
* Active and unrestricted RN license for state of Texas.
* 2+ years of direct clinical practice experience as an RN e.g.,
hospital setting or alternative care setting such as ambulatory
care or outpatient clinic/facility
* Willing and able to travel upto 50% of their time to meet members
face to face in South dallas, Ellis and Navarro Counties in TX and
surrounding areas.
* Reliable transportation required Mileage is reimbursed per our
company expense reimbursement policy
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues 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, religious
belief, or other legally recognized reasons that prevents them from
being 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 or apply for a reasonable accommodation within
the first 10 days of your employment. Please note that in some
states and roles, you may be required to provide proof of full
vaccination or an approved reasonable accommodation before you can
begin to actively work.
Preferred Qualifications
* Crisis intervention skills
* Managed care/utilization review experience
* Case management and discharge planning experience
* Bilingual a plus (Spanish)
Education
Associate degree required and 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.
Keywords: CVS Health, Irving , Case Manager RN- Field - Case Management, Healthcare , Irving, Texas
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