Position Summary
This is a field-based position with expected travel of 50-75% to meet with members face to face in Winnebago County of IL and surrounding areas.
Strongly prefers candidates to reside in the Rockford area.
Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.
Nurse Case Manager 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.
– Through the use of 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.
– Assessments take into account 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.
– Assessments include the member’s level of work capacity and related restrictions/limitations.
– 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.
Required Qualifications:
– Minimum 3 years of clinical practice experience required.
– Current Active unrestricted RN licensure in the state of IL required.
– Willing and able to travel 50-75% of their time to meet members face to face in Winnebago County of IL and surrounding areas.
-Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
–Minimum 1 year experience in MS office suite applications.
Preferred Qualifications
– Case Management in an integrated model preferred.
– Experience working with adults with Behavioral Health needs preferred.
– Long Term care experience in Nursing Home setting preferred
Education
Associate's degree with RN licensure required; BSN preferred
Woonsocket, RI
CVS Health Corporation provides health services and plans in the United States. Its Pharmacy Services segment offers pharmacy benefit management solutions, such as plan design and administration, formulary management, retail pharmacy network management, mail order pharmacy, specialty pharmacy and infusion, Medicare Part D, clinical, disease management, and medical spend management services. The company’s Retail/LTC segment sells prescription drugs and general merchandise, such as over-the-counter drugs, beauty products, cosmetics, and personal care products, as well as provides health care services through its MinuteClinic walk-in medical clinics.
Its Health Care Benefits segment offers traditional, voluntary, and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, medical management, Medicare plans, PDPs, Medicaid health care management services, workers’ compensation administrative services, and health information technology products and services. The company’s customers include employers, insurance companies, unions, government employee groups, health plans, Medicare Part D prescription drug plans, Medicaid managed care plans, plans offered on public health insurance exchanges and private health insurance exchanges, other sponsors of health benefit plans, individuals, college students, workers, labor groups, and expatriates.
As of December 31, 2018, it had approximately 40 leased on-site pharmacies, 25 leased retail specialty pharmacy stores, 20 specialty mail order pharmacies, and 90 branches for infusion and enteral services; and 9,900 retail locations and 1,100 MinuteClinic locations, as well as operated an online retail pharmacy Websites, LTC pharmacies, and onsite pharmacies. The company was formerly known as CVS Caremark Corporation and changed its name to CVS Health Corporation in September 2014. CVS Health Corporation was founded in 1963 and is headquartered in Woonsocket, Rhode Island.