Case Manager RN - Two Rivers Region KY
Case Manager RN - Two Rivers Region KY
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$ 54095 - 116760
1 Vacancy
Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven colleagues caring for people where when and how they choose in a way that is uniquely more connected more convenient and more compassionate. And we do it all with heart each and every day.
Position Summary
The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess plan implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the members improved health. The Case Manager develops a proactive course of action to address issues presented to enhance the short and longterm outcomes as well as opportunities to enhance a members overall wellness. Services strategies policies and programs are comprised of network management and clinical coverage policies.
This is a fieldbased position that requires routine regional instate travel 8090 of the time; use of personal vehicle is required. Qualified candidates must have valid KY drivers license proof of vehicle insurance and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training. This position is assigned to the Two Rivers Region. Qualified candidates must reside in one of the counties within the specified region.
Evaluation of Members:
- Through the use of clinical assessment tools and evaluating information/data review conducts a comprehensive and holistic evaluation of members 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.
- Integrates assessment data from all care partners to holistically address all physical and behavioral health conditions including comorbid and multiple diagnoses that impact functionality and member wellbeing.
- Creates monitors and revise member care plans to comprehensively address member biopsychosocial care needs.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessments include the members functional capacity and related restrictions/limitations.
- Using a holistic approach assesses the need for a referral to additional clinical resources for assistance in determining functionality.
- Consults with supervisor and other care partners to overcome 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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Helps member actively and knowledgably participate with their provider in healthcare decisionmaking.
- Fieldbased working environment with productivity and quality expectations
- Work requires the ability to perform close inspection of handwritten and computergenerated documents as well as a PC monitor
- Sedentary work involving periods of sitting talking listening.
- Work requires sitting for extended periods talking on the telephone and typing on the computer.
- Ability to multitask prioritize and effectively adapt to a fastpaced changing environment.
Required Qualifications
- 3 years clinical practice experience including patient care coordination and health assessments
- RN with current unrestricted state licensure in KY
- 2 years experience using personal computer keyboard navigation navigating multiple systems and applications; and using MS Office Suite applications (Teams Outlook Word Excel etc.
- Must possess reliable transportation and be willing and able to travel in the Two Rivers Region up to 8090 of the time. Mileage is reimbursed per our company expense reimbursement policy.
- Flexibility to work beyond core business hours of MondayFriday 8am5pm CST
- Candidate must reside in one of the following counties of the service region:
Union Henderson Webster McLean Daviess Hancock Ohio Butler Logan Warren Edmonson Hart Barren Metcalfe Monroe Allen Simpson Logan counties in KY
Preferred Qualifications
- Candidates residing in Warren County or an adjacent county
- Experience or detailed knowledge of the Foster Care and juvenile justice systems Adoption Assistance the delivery of Behavioral Health Services Traumainformed Care ACEs Crisis Intervention services and evidencebased practices applicable to the Kentucky SKY populations
- Case Management in an integrated model
- Discharge Planning Experience
- Motivational Interviewing skills
- Managed Care/Utilization Review Experience
- Clinical experience and demonstrated knowledge of age appropriate developmental milestones
- Clinical experience and understanding of complex medical conditions and treatment plans
- Effective communication skills both verbal and written
- Bilingual
Education
- Minimum of an Associates degree in Nursing or Diploma RN
- BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54095.00 $116760.00This pay range represents the base hourly rate or base annual fulltime 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 shortterm incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:
Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.
Nocost programs for all colleagues including wellness screenings tobacco cessation and weight management programs confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off flexible work schedules family leave dependent care resources colleague assistance programs tuition assistance retiree medical access and many other benefits depending on eligibility.
Required Experience:
Manager
Employment Type
Full-Time
