Case Manager Registered Nurse - Field (Wayne and Macomb Counties) at CVS Health

Michigan City, Mississippi, 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 a remote role with 25-50% travel within Southeast Michigan (Wayne and Macomb Counties)
Dedicated workspace free of interruptions
Dependents must have separate care arrangements during work hours

Responsibilities

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 a 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
Assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness

Skills

Key technologies and capabilities for this role

Registered NurseCase ManagementCare CoordinationAssessmentPlanningMedicareMedicaidDual EligibleHealthcarePatient Advocacy

Questions & Answers

Common questions about this position

Is this a remote position, and what travel is required?

This role is work at home with 25-50% travel within Southeast Michigan (Wayne and Macomb Counties).

What is the work schedule for this position?

The schedule is standard business hours Monday-Friday 8:00am-5:00pm EST, with no nights, weekends, or holidays, and potential to move to a four-day/ten-hour shift after a 6-month probationary period.

What are the key responsibilities of this Case Manager role?

Key responsibilities include visiting members in their homes to evaluate for waiver services, developing proactive plans of care, using clinical tools for evaluations, applying clinical judgment to reduce risks, and conducting assessments from various sources.

What is the company culture like at CVS Health for this role?

The culture emphasizes building a world of health with passionate, purpose-driven colleagues who provide compassionate, connected care, focusing on transforming health care for dual eligible populations with complex needs.

What qualifications make a strong candidate for this Case Manager position?

Strong candidates are Registered Nurses with clinical judgment, experience in case management, assessing member needs, and coordinating care for complex health and social challenges, particularly for dual eligible Medicare and Medicaid populations.

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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