Case Manager - Registered Nurse – Field – PA Chester County + Lancaster at CVS Health

Alburtis, Pennsylvania, 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) license
Ability to work in the field in PA Chester County + Lancaster, including home visits, worksites, or physician’s offices
Experience or capability in telephonic and in-person interactions with members/clients
Knowledge of laws and regulations related to rehabilitation services, insurance carriers, and referral sources

Responsibilities

Facilitate delivery of appropriate benefits and healthcare information, determining eligibility while promoting wellness activities
Develop, implement, and support health strategies, tactics, policies, and programs for member wellness and return to work
Act as a liaison with members/clients/families, employers, providers, insurance companies, and healthcare personnel
Implement and coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care, including consultant referrals, home care visits, community resources, and alternative care levels
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, return to work, or functioning, and determine benefit eligibility
Communicate with members/clients and stakeholders (e.g., providers, attorneys, employers, insurance carriers) telephonically or in person
Prepare required documentation of case work activities
Interact and consult with internal multidisciplinary teams to maximize health outcomes
Make outreach to treating physicians or specialists regarding course of care and treatment
Provide educational and prevention information for best medical outcomes
Apply laws, regulations, special instructions from insurance carriers and referral sources
Testify as required to substantiate case work or reports
Conduct evaluations of members'/clients' needs and benefit plan eligibility

Skills

Registered Nurse

Case Management

Care Coordination

Health Assessment

Care Planning

Facilitation

Evaluation

Patient Advocacy

Wellness Programs

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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