Job Description

Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing
impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate
attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’
health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets
across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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 plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s
overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which
impact care planning.
• Conducts assessments that consider information from various sources, such
as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
• 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 conversation.

Required Qualifications

– Minimum 3 or more years clinical practical experience.
– Registered Nurse with active MI state license in good standing is required.
– Must be willing to travel 40-50% in MI Counties: Wayne, Macomb, Michigan, Barry, Berrien, Branch, Calhoun, Cass, Kalamozoo, St. Joseph, Van Buren and surrounding areas

COVID Requirements

COVID-19 Vaccination Requirement
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.

Preferred Qualifications

– Minimum 2 or more years case management, discharge planning and/or home health care coordination experience.
– Bachelor’s degree preferred.
– Certified Case Manager is preferred.
– Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required
– Excellent analytical and problem-solving skills
– Effective communications, organizational, and interpersonal skills.
– Ability to work independently (may require working from home).
– Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
– Efficient and Effective computer skills including navigating multiple systems and keyboarding
– Willing and able to obtain multi state RN licenses if needed, company will provide

Education

Associates degree required, BSN preferred

Business Overview

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.