Case Manager RN - Military Veterans
at CVS Health
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 remote work from home role anywhere in the US with virtual training.
Shift schedule is 8:30am - 5pm within time zone of residence.
American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.
- This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- 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
- Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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
- Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
- Utilizes case management processes in compliance with regulatory and company policies and procedures
- Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations
- Identifies and escalates member’s needs appropriately following set guidelines and protocols
- Need to actively reach out to members to collaborate/guide their care
- Perform medical necessity reviews
Required Qualifications
- 5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting
- A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states
- 1+ years’ experience documenting electronically using a keyboard
- 1+ years’ current or previous experience in Oncology, Transplant, Medical/Surgical, or Specialty Pharmacy
Preferred Qualifications
- 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
- 1+ years' experience in Utilization Review
- CCM and/or other URAC recognized accreditation preferred
- 1+ years’ experience with MCG, NCCN and/or Lexicomp
- Bilingual in Spanish preferred
Education
- Diploma or Associates Degree in Nursing required
- BSN preferred
Pay Range
The typical pay range for this role is:
$54,095.60 - $116,760.80This 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 Benefits | CVS Health
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
AR
At CVS Health we are transforming health care with a shared purpose: Bringing our heart to every moment of your health™
With 300,000 dedicated colleagues including veterans, service members, Guard and Reserve, and military spouses, we are improving the health of communities across America.
We recognize the value of military service and know that the skills and experience our nation's veterans and military spouses possess are unparalleled. As a CVS Health colleague, you’ll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone’s life, including your own.
As an enduring partner with Military Spouse Employment Partnership for 20 years, we’re committed to providing long-term career potential, opportunity, and support for military spouses.
Corporate Fellowship Programs
Transitioning Service Members - For transitioning service members and Coast Guardsmen within 180 days of separation from service interested in SkillBridge programs, please reach out to YourNextMission@CVSHealth.com to learn about the career tracks that we host participants in.
Accommodation Statement
We provide reasonable accommodations to individuals with disabilities as needed. To request an accommodation – including a qualified interpreter, written information in other formats, translation or other services – please email AdviceandCounsel@cvshealth.com or call 877-805-9511. 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.
EEO Statement
CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT.
Military Spouses - We offer programs throughout the year and have partnered with Hiring Our Heroes to offer a 12-week paid fellowship for military spouses. During this time, you will receive professional training and hands-on experiences across CVS Health enterprise to quickly build your network and showcase your skillset. If you are interested in Military Spouse Fellowship programs, please reach out to our partners at Hiring Our Heroes.