Case Manager Registered Nurse - Field Must Reside in Bowling Green or Ashland Virginia at CVS Health

Pineville, Kentucky, 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 Bowling Green or Ashland region of Virginia
Must possess reliable transportation and be willing and able to travel up to 50-75% of the time (mileage reimbursed per company policy)
RN or BH with current unrestricted Virginia state licensure required (LPN also mentioned as eligible)
Associate’s Degree, preferably in Nursing, with active Registered Nurse (RN) licensure
3 years clinical experience (preferably in Medical-Surgical Nursing, Behavioral Health, Long Term Care, etc.)
1+ years managed care experience
Proficiency with computer skills, including navigating multiple systems and keyboarding
Ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor
Ability to sit for extended periods, talk on the telephone, and type on the computer

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 conduct evaluations of member needs and benefit plan eligibility, facilitating integrative functions and smooth transitions to Aetna programs and plans
Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers, addressing complex health and social indicators impacting care planning and resolution of member issues
Conduct assessments taking into account information from various sources to address all conditions, including co-morbid and multiple diagnoses impacting functionality
Review prior claims to address potential impact on current case management and eligibility
Assess member’s level of work capacity and related restrictions/limitations using a holistic approach, including need for referral to clinical resources
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

LPN

BH License

Case Management

Long-Term Services and Supports

Assessment

Care Planning

Member Coordination

Clinical Tools

Network Management

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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