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Requisition Job Description

The Case Manager RN position is 100% remote and employees can live in any state.

Normal Working Hours: Monday through Friday 9:00am - 5:30pm EST. There is a late shift requirement once a quarter 12:30-9:00pm EST

Weekends are not required.

Holidays are covered on a volunteer basis.

There is no travel expected with this position.

This Case Manager RN position is part of Aetna's Commercial Care Management division.

The RN's Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with member to evaluate the medical needs of the member facilitate the member's overall wellness.

RN Case Manager :

Develop 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 function as well as smooth transition to Aetna's programs and plans

Applies clinical judgement to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of members issues.

Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnosis that impact functionality.

Reviews prior claims to address potential impact on current case management and eligibility.

Assessments include 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 and meeting goals and objectives, presents cases at case conference for 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.

Required Qualifications

Must have an active current and unrestricted RN licensure in the state of residence

Must be willing to obtain multiple state RN licensure after hire (expenses paid for by company)

2+ years as an RN with med/surge experience

Must be willing to work Monday - Friday 9:00am - 530pm EST

Must be willing to work late shift once per quarter until 9pm EST

1+ year experience with all types of Microsoft Office including Power Point , Excel, and Word

Preferred Qualifications

2+ years of Case Management experience

Strong telephonic communication skills

Certified Case Manager(CCM) certification

Education

Associates degree in Nursing

BSN preferred

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

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

We anticipate the application window for this opening will close on: 08/07/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.