[Remote] Care Manager – Registered Nurse at CVS Health

Georgia, Vermont, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Active and unrestricted Registered Nurse (RN) licensure in the state of Georgia (GA) OR Compact Registered Nurse (RN) license in state of residence
Proficient in Microsoft (tools implied, e.g., Office suite)
Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements
Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care
Familiarity with community resources and services
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records
Strong collaborative and professional relationships with members and colleagues
Effective verbal and written communication skills
Excellent customer service and engagement skills
Conduct oneself with integrity, professionalism, and self-direction

Responsibilities

Coordinate care for members with multiple chronic medical and behavioral health conditions, as well as social determinants of health (SDoH) needs (50-75% telephonic engagement)
Conduct comprehensive assessments to evaluate members’ needs
Address SDoH challenges by connecting members with appropriate resources and support services
Provide education and guidance to members and families on managing chronic conditions and navigating the healthcare system
Develop and implement individualized care plans encompassing goals and interventions
Monitor member progress and advocate for necessary services
Collaborate with the interdisciplinary care team to ensure optimal health outcomes and address barriers to care
Maintain meticulous and timely documentation of assessments and interventions in the electronic health record
Participate in team meetings to discuss member status and care strategies
Provide evidence-based disease management education and support
Ensure appropriate interdisciplinary care team members are involved
Identify and connect members with health plan benefits and community resources
Meet regulatory requirements within specified timelines
Support other Care Team members through clinical decision making and guidance
Perform additional responsibilities as assigned, such as special projects, process improvements, or mentoring

Skills

Registered Nurse

Care Coordination

Case Management

Chronic Disease Management

Telephonic Engagement

Care Planning

Assessment

Documentation

Interdisciplinary Collaboration

SDoH

Disease Management Education

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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