Case Manager Registered Nurse - Field (Southwest Michigan) at CVS Health

Kalamazoo, Michigan, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Registered Nurse with active MI state license in good standing
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Ability to travel within a designated geographic area (25-50% travel within SW Michigan: Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties) for in-person case management activities as directed by Leadership and/or as business needs arise
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Effective computer skills including navigating multiple systems and keyboarding
Demonstrates proficiency with standard corporate software applications

Responsibilities

Assessing, planning, implementing, and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness
Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval
Developing a proactive plan of care to address identified issues to enhance short and long-term outcomes as well as opportunities to enhance member’s overall wellness
Using clinical tools and information/data review to conduct an evaluation of member’s needs and benefits
Applying clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning
Conducting assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
Using a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
Collaborating with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presenting cases at interdisciplinary case conferences
Utilizing case management processes in compliance with regulatory and company policies and procedures
Utilizing motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Skills

Case Management

Care Management

Medicare

Medicaid

Patient Assessment

Care Coordination

Healthcare Navigation

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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