Case Manager, Registered Nurse - Field at CVS Health

Kansas City, Kansas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Registered Nurse (RN) licensure
Ability to travel up to 75%
Availability for Monday through Friday 8:00 AM - 5:00 PM CST schedule
Knowledge of laws and regulations related to rehabilitation services, insurance carriers, and referral sources

Responsibilities

Act as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel
Implement and coordinate case management activities for catastrophic cases and chronically ill members/clients across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care
Interact with members/clients telephonically or in person, including meetings in homes, worksites, or physician’s offices
Assess and analyze injured, acute, or chronically ill members/clients' medical and/or vocational status; develop a plan of care to optimize wellness, medical outcomes, timely return to work or optimal functioning, and determine eligibility for benefits
Communicate with member/client and stakeholders (e.g., medical providers, attorneys, employers, insurance carriers) telephonically or in person
Prepare all required documentation of case work activities
Interact and consult with internal multidisciplinary team to maximize member/client health outcomes
Make outreach to treating physicians or specialists concerning course of care and treatment
Provide educational and prevention information for best medical outcomes
Testify as required to substantiate case management activities
Facilitate delivery of appropriate benefits and/or healthcare information to determine eligibility while promoting wellness activities
Develop, implement, and support health strategies, tactics, policies, and programs for member wellness and return to work, including network management, clinical coverage, and policies
Use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals’ and families’ comprehensive health needs through communication and resources for quality, cost-effective outcomes

Skills

Key technologies and capabilities for this role

Registered NurseCase ManagementCare CoordinationPatient AssessmentCare PlanningHealth AdvocacyWellness ProgramsNetwork Management

Questions & Answers

Common questions about this position

Is this a remote position or does it require travel?

The role is field-based and requires up to 75% travel, with interactions that may include meeting members in their homes, worksites, or physician’s offices.

What is the work schedule for this Case Manager role?

The schedule is Monday through Friday, 8:00 AM - 5:00 PM Central Standard Time (CST).

What are the main responsibilities of this position?

Responsibilities include facilitating delivery of benefits and healthcare information, developing health strategies, coordinating case management for catastrophic and chronically ill members, acting as a liaison with members, families, providers, and others, and assessing medical/vocational status to develop care plans.

What qualifications are needed for this Case Manager role?

The position requires being a Registered Nurse, with skills in assessment, planning, facilitation, care coordination, evaluation, advocacy, and excellent communication.

What is the company culture like at CVS Health for this team?

The culture emphasizes compassionate, member-centric care, collaboration with members, providers, and community organizations, and a team-delivered approach with over 300,000 purpose-driven colleagues focused on transforming health care.

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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