Case Manager, Registered Nurse (Field - Illinois) at CVS Health

Schaumburg, Illinois, 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 required
Ability to act as a liaison with members/clients/families, employers, providers, insurance companies, and healthcare personnel
Skills in assessment and analysis of injured, acute, or chronically ill members/clients' medical and/or vocational status
Ability to develop, implement, and coordinate case management activities, including for catastrophic cases and chronically ill members across the continuum of care (e.g., consultant referrals, home care visits, community resources, alternative levels of care)
Proficiency in telephonic and in-person interactions with members/clients, including home visits, worksites, or physician’s offices
Strong communication skills with members/clients and stakeholders (e.g., medical providers, attorneys, employers, insurance carriers)
Capability to prepare required documentation of case work activities
Experience interacting and consulting with internal multidisciplinary teams
Ability to make outreach to treating physicians or specialists regarding course of care and treatment
Knowledge to provide educational and prevention information for optimal medical outcomes
Understanding of laws, regulations, special instructions for rehabilitation services, insurance carriers, and referral sources
Skills in evaluating members/clients’ needs, benefit plan eligibility, and facilitating integrative functions using clinical tools and data
Field-based role in Illinois, requiring travel for in-person meetings (e.g., homes, worksites, physician offices)

Responsibilities

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 timely return to work
Use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals’ and families’ comprehensive health needs
Implement and coordinate case management activities for catastrophic cases and chronically ill members/clients across the continuum of care
Interact with members/clients telephonically or in person, including home, worksite, or physician office visits
Assess and analyze medical/vocational status; develop plans of care to optimize wellness, medical outcomes, return to work, or functioning; determine benefit eligibility
Communicate with members/clients and stakeholders (e.g., providers, attorneys, employers, carriers) telephonically or in person
Prepare all required documentation of case work activities
Interact and consult with internal multidisciplinary teams to maximize health outcomes
Make outreach to treating physicians or specialists concerning care and treatment
Provide educational and prevention information for best medical outcomes
Apply relevant laws, regulations, and special instructions from insurance carriers and referral sources
Conduct evaluations of needs and benefit plan eligibility; facilitate integrative functions using clinical tools and data

Skills

Registered Nurse

Case Management

Care Coordination

Health Assessment

Patient Advocacy

Medicare

Medicaid

Wellness Programs

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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