Description
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.
Position Summary
This is a full-time telework position. Travel is required up to 50% of the time in the Northern region of West Virginia. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities.
The schedule is Monday - Friday, 8am-5pm, standard business hours. No nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.
The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia's Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state. The health plan truly embodies the commitment of West Virginian's helping West Virginian's. At Aetna Better Health of West Virginia, you can be the very best you can be working with strong teams committed to helping our members and with opportunities for career growth. We will support you all the way!
The Case Manager RN (CM RN) is responsible for telephonically and/or face to face 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. Services strategies policies and programs are comprised of network management and clinical coverage policies. This position is heavy community-based with some onsite presence at Department of Health and Human Resources (DHHR) offices.
Fundamental Components:
- Conducts face to face member visits
- Using clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
- Applies clinical judgment 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 member issues.
- Assesses information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- 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 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.
- Effective communication skills, both verbal and written.
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
Required Qualifications
West Virginia residency is required.
Must reside in Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Mon, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, Wetzel or an adjacent county.
Must possess reliable transportation and be willing and able to travel in the assigned region up to 50% of the time. Mileage is reimbursed per our company expense reimbursement policy.
Registered Nurse with current unrestricted West Virginia (WV) license or Registered Nurse with current unrestricted WV "multi-state privilege" license
5+ years' clinical practice experience
2+ years' experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Preferred Qualifications
Medicaid experience
Waiver experience
Foster care experience
Crisis intervention skills
Managed care/utilization review experience
Certified Case Manager (CCM) certification
Case management experience in an integrated model
Case management and discharge planning experience
Familiarity with QuickBase
Experience using Electronic Medical Records (EMR)
Education
Minimum of an Associate degree in Nursing or Diploma in Nursing
BSN degree preferred
Pay Range
The typical pay range for this role is:
$54,095.60 - $116,800.00
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 wit
Compensation Information:
$54095.6 / Yearly - $54095.6 / Yearly
Starting At: 54095.6 Yearly
Up To: 116800.0 Yearly
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