Case Manager Registered Nurse - Field – Must reside in Bedford Virginia or Surrounding Areas at CVS Health

Bedford, Virginia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in Bedford, Virginia or surrounding areas
Must possess reliable transportation and be willing and able to travel up to 50-75% of the time (mileage reimbursed per company policy)
RN with current unrestricted Virginia state licensure required (or BH License)
3 years clinical experience (preferably in Medical-Surgical Nursing, Behavioral Health, Long Term Care, etc.)
Proficiency with computer skills, including navigating multiple systems and keyboarding
Associate's Degree in Nursing required (Bachelor's Degree in Science & Nursing preferred)

Responsibilities

Assess, plan, implement, and coordinate all case management activities with members to evaluate medical needs and facilitate overall wellness
Develop a proactive course of action to address issues, enhance short- and long-term outcomes, and integrate services, strategies, policies, and programs
Use clinical tools and information/data review to evaluate member's needs, benefit plan eligibility, and facilitate integrative functions and smooth transitions to Aetna programs and plans
Apply clinical judgment to incorporate strategies that reduce risk factors and barriers, addressing complex health and social indicators impacting care planning and resolution of member issues
Conduct assessments considering information from various sources, including co-morbid and multiple diagnoses impacting functionality, prior claims, work capacity, and restrictions/limitations
Use a holistic approach to assess need for referral to clinical resources for assistance in determining functionality
Consult with supervisor and others to overcome barriers in meeting goals and objectives; present cases at case conferences for multidisciplinary focus
Utilize case management processes in compliance with regulatory and company policies and procedures
Utilize interviewing skills to ensure maximum member engagement and discern health status and needs based on key questions and conversation

Skills

Key technologies and capabilities for this role

RN LicenseCase ManagementLong-Term Services and SupportsPatient AssessmentCare PlanningCare CoordinationClinical Documentation

Questions & Answers

Common questions about this position

What license is required for this Case Manager position?

Candidates must hold a Virginia RN or BH License.

Is this a remote position or does it require travel?

This is a field-based position requiring candidates to reside in Bedford, Virginia or surrounding areas, with up to 50-75% travel to meet members face-to-face. It involves a typical office working environment with sedentary work, sitting for extended periods, and use of a PC.

Where must candidates reside for this role?

Candidates must reside in Bedford, Virginia or surrounding areas.

What are the main responsibilities of the Nurse Case Manager?

The Nurse Case Manager assesses, plans, implements, and coordinates case management activities with members to evaluate medical needs, facilitate wellness, develop proactive courses of action, and apply clinical judgment to reduce risk factors and barriers.

What is the employment type for this position?

This is a full-time position.

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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