Case Manager - Registered Nurse
CVS HealthFull Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Candidates must reside in Illinois, preferably in Peoria, Pekin, Macomb, Galesburg, or Springfield. A Registered Nurse (RN) license in Illinois without disciplinary action is required, along with at least 2 years of experience in home-based case/care management and clinical nursing experience (hospital, acute care, or home health). The role demands the ability to travel 75-90% within Illinois, knowledge of community health and social service agencies, exceptional communication and interpersonal skills, and the ability to work with minimal supervision. Proficiency in electronic health records and intermediate to advanced computer skills with Microsoft Word, Outlook, and Excel are necessary. A valid state driver's license and proof of personal vehicle liability insurance with specific limits are also mandatory. Preferred qualifications include a BSN, experience with Medicare/Medicaid members, health promotion/coaching/wellness experience, previous managed care experience, bilingual English/Spanish skills, Case Management certification, and Motivational Interviewing certification or knowledge.
The Field Care Manager Registered Nurse will assess and evaluate member needs to achieve optimal wellness, guiding them toward appropriate resources. Responsibilities include identifying and resolving barriers to effective care, monitoring patient progress through assessments, creating plans of care, and communicating with internal and external stakeholders. The role involves understanding department and organizational strategy, making independent decisions regarding work methods with minimal direction, and following established guidelines. Field visits to Medicaid members in their homes, supportive living facilities, long-term care facilities, and other care settings will constitute 75-90% of the job. The position is patient-facing and requires participation in Humana's Tuberculosis (TB) screening program and Driver Safety program.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.