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Position Summary
This position will be serving the Northern Virginia area. Qualified candidates must live in Warren County, Frederick County and surrounding areas.
Approximately 50-75% of field based travel.
Monday-Friday 8am-5pm EST.
Nurse Case Manager is responsible for telephonically and/or face to faceassessing, planning, implementing and coordinating all case managementactivities with members to evaluate the medical needs of the member tofacilitate the member’s overall wellness. Develops a proactive course ofaction to address issues presented to enhance the short and long-termoutcomes as well as opportunities to enhance a member’s overall wellnessthrough integration. Services strategies policies and programs arecomprised of network management and clinical coverage policies.
Through the use of clinical tools and information/data review, conducts anevaluation of member's needs and benefit plan eligibility and facilitatesintegrative functions as well as smooth transition to Aetna programs andplans. Applies clinical judgment to the incorporation of strategies designedto reduce risk factors and barriers and address complex health and socialindicators which impact care planning and resolution of member issues.Assessments take into account information from various sources to addressall conditions including co-morbid and multiple diagnoses that impactfunctionality. Reviews prior claims to address potential impact on currentcase management and eligibility. Assessments include the member’s level ofwork capacity and related restrictions/limitations. Using a holistic approachassess the need for a referral to clinical resources for assistance indetermining functionality. Consults with supervisor and others inovercoming barriers in meeting goals and objectives, presents cases atcase conferences for multidisciplinary focus to benefit overall claimmanagement. Utilizes case management processes in compliance withregulatory and company policies and procedures. Utilizes interviewing skillsto ensure maximum member engagement and discern their health statusand health needs based on key questions and conversation. Required Qualifications -RN with current unrestricted Virginia state licensure required -2+ years clinical experience in acute care setting
Must possess reliable transportation and be willing and able to travel in-state up to 50-75% of the time. Mileage is reimbursed per our company expense reimbursement policy. Preferred Qualifications -Case Management in an integrated model preferred -Bilingual in English/Spanish preferred - Ability to multitask, prioritize and effectively adapt to a fast paced changing environment -Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. -Effective communication skills, both verbal and written.
Education -Associate's degree minimum
-Bachelor's in Nursing preferred
Pay Range
The typical pay range for this role is:
$69,628.00 - $149,400.00
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
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.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.