Case Manager Registered Nurse - Field – Must reside in Roanoke, Rocky Mount, & Surrounding areas at CVS Health

Rocky Mount, Virginia, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

RN with current unrestricted Virginia state licensure required
Associates Degree in Nursing required
3 years clinical experience (med surg, behavioral health)
2+ years Managed Care experience
Must reside in Roanoke, Rocky Mount, Martinsville or surrounding areas
Must possess reliable transportation and be willing and able to travel up to 75% of the time to meet with members face to face
Valid Driver’s License

Responsibilities

Assessing, planning, implementing and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness
Developing a proactive course of action to address issues and enhance short- and long-term outcomes through integration of services, strategies, policies, and programs
Conducting evaluations of member’s needs and benefit plan eligibility using clinical tools and data review, facilitating transitions to Aetna programs and plans
Applying clinical judgment to incorporate strategies that reduce risk factors and barriers, addressing complex health and social indicators impacting care planning
Performing assessments considering information from various sources, including co-morbid and multiple diagnoses, prior claims, work capacity, restrictions/limitations, and holistic needs for referrals
Consulting with supervisor and others to overcome barriers, presenting cases at case conferences for multidisciplinary focus
Utilizing case management processes in compliance with regulatory and company policies and procedures
Utilizing interviewing skills to ensure maximum member engagement and discern health status and needs

Skills

Registered Nurse

Case Management

Clinical Assessment

Care Planning

Health Risk Assessment

Benefit Plan Review

Clinical Judgment

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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