Case Manager RN - Western Region WV - Military Veterans

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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 field teleworker position with some travel is 10% of the time, in the western region of WV. Qualified candidates must reside in the region, in one of the following counties or an adjacent: Wood, Wirt, Jackson, Mason, Putnam, Cabell, Lincoln, or Wayne.

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 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 WV Department of Human Services (DoHS) 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 manager 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

• Registered Nurse with current unrestricted West Virginia (WV) license or compact RN license
• Travel required up to 10% of the time to meet members face-to-face, in the western region of WV: Wood, Wirt, Jackson, Mason, Putnam, Cabell, Lincoln, and Wayne County. Must possess reliable transportation. Mileage is reimbursed per our company expense reimbursement policy.
• 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

• Behavioral health experience
• SUD experience
• Case management and discharge planning experience
• Medicaid experience
• Crisis intervention skills
• Managed care experience
• Certified Case Manager (CCM) certification
• Familiarity with QuickBase

Education

• Associate degree in nursing or nursing diploma required
• BSN preferred

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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 Benefits | CVS Health

We anticipate the application window for this opening will close on: 03/01/2025

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