Case Manager - Registered Nurse, Northwest Cook County (Field) at CVS Health

Downers Grove, Illinois, 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 act as a liaison with members/clients/families, employers, providers, insurance companies, and healthcare personnel
Skills in implementing and coordinating 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 levels of care
Capability to interact with members/clients telephonically or in person, including meetings in homes, worksites, or physician’s offices
Proficiency in assessing and analyzing injured, acute, or chronically ill members'/clients' medical and/or vocational status
Experience developing plans of care to optimize wellness, medical outcomes, timely return to work, optimal functioning, and benefit eligibility
Strong communication skills with members/clients and stakeholders (e.g., medical providers, attorneys, employers, insurance carriers) via phone or in person
Ability to prepare required documentation of case work activities
Skills in interacting and consulting with internal multidisciplinary teams
Capability to make outreach to treating physicians or specialists regarding course of care and treatment
Knowledge to provide educational and prevention information for optimal medical outcomes
Understanding of applicable laws, regulations, special instructions from insurance carriers, and referral sources for rehabilitation services
Ability to conduct evaluations of members'/clients' needs and benefit plan eligibility using clinical tools and data
Compliance with case management processes

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 benefit delivery, member wellness, and timely return to work
Use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals' and families' comprehensive health needs
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/clients across the continuum of care
Interact with members/clients telephonically or in person, including home, worksite, or physician’s office visits
Assess and analyze medical and/or vocational status; develop plans of care for condition management, wellness, outcomes, return to work, functioning, and benefit eligibility
Communicate with members/clients and stakeholders (e.g., providers, attorneys, employers, carriers) telephonically or in person
Prepare all required documentation of case work activities
Interact and consult with internal multidisciplinary teams to maximize health outcomes
Make outreach to treating physicians or specialists concerning care and treatment
Provide educational and prevention information for best medical outcomes
Apply laws, regulations, and special instructions for rehabilitation services, insurance carriers, and referral sources
Evaluate members'/clients' needs and benefit plan eligibility; facilitate integrative functions using clinical tools and data
Utilize case management processes in compliance with standards

Skills

Registered Nurse

Case Management

Care Coordination

Health Assessment

Patient Advocacy

Medicare

Medicaid

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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