Case Manager - Registered Nurse – Field – PA Good Samaritan Hospital at CVS Health

Alburtis, Pennsylvania, United States

CVS Health Logo
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • Registered Nurse (RN) licensure
  • Ability to interact with members/clients telephonically or in person, including home visits, worksites, or physician’s offices
  • Knowledge of laws and regulations applicable to rehabilitation services, special instructions from insurance carriers and referral sources
  • Capability to assess and analyze medical and/or vocational status of injured, acute, or chronically ill members/clients
  • Skills in documentation of case work activities

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 return to work
  • Act as a liaison with member/client/family, employer, provider(s), 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., medical providers, attorneys, employers, insurance carriers) telephonically or in person
  • Prepare required documentation of case work activities
  • Interact and consult with internal multidisciplinary team 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
  • Testify as required to substantiate case work or reports
  • Conduct evaluation of members/clients’ needs and benefit plan eligibility

Skills

Key technologies and capabilities for this role

Registered NurseCase ManagementCare CoordinationPatient AdvocacyHealth AssessmentCare PlanningWellness ProgramsNetwork Management

Questions & Answers

Common questions about this position

Is this a remote position or does it require field work?

This is a field-based role where the Case Manager may be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services, and interacts telephonically or in person.

What qualifications are required for this Case Manager role?

The role requires being a Registered Nurse, as indicated by the job title, with skills in assessment, planning, facilitation, care coordination, evaluation, and advocacy for members' health needs.

What does the Community Care team focus on?

The Community Care team uses a member-centric, team-delivered, community-based care management model that joins members where they are, collaborating with members, providers, and community organizations to address health care and social determinant needs.

What are the main responsibilities of the Case Manager?

Responsibilities include facilitating delivery of benefits and healthcare information, developing health strategies, acting as a liaison with members, families, employers, providers, implementing case management for catastrophic and chronic cases, and assessing medical/vocational status to develop care plans.

What makes a strong candidate for this position?

A strong candidate is a dedicated Registered Nurse passionate about transforming health care, with excellent communication skills, ability to collaborate with diverse stakeholders, and experience in care coordination across the continuum of care including home visits.

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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