Telephonic Nurse Care Manager
HumanaFull Time
Mid-level (3 to 4 years)
Candidates must possess a High School Diploma or Associate's degree, with a Bachelor's degree being preferred. A minimum of 5 years of experience as a Registered Nurse is required, along with at least 1 year of Nursing Management experience in specific patient populations such as Diabetes, Cardiac Disease, ICU, CCU, Home Health, or Pulmonary Disease. Proficiency in electronic documentation using a keyboard and multiple computer screens, including free-form text and Microsoft Office applications (especially Excel), is necessary. An active and unrestricted RN licensure in the state of residence is mandatory, and Compact Licensure RN License is required. Preferred qualifications include 1+ years of current or previous Home Health and/or Case Management experience, 1+ years of experience with Lexicomp, and 1+ years of experience with Motivational Interviewing. Certification as a Diabetes Care and Education Specialist (CDCES) and bilingual skills in Spanish are also preferred. Candidates must have hard-wired internet access.
The Health Coach Consultant will work as a telephonic case manager, intensely engaging with patients and their care teams to enhance medical appropriateness and the quality of care. This involves applying clinical judgment and interpreting criteria, guidelines, policies, and regulatory standards to assess benefits and member needs. The role requires identifying and addressing risk factors, barriers, and complex health and social indicators impacting care planning through a holistic approach. Consultants will utilize motivational interviewing skills to maximize member engagement, assess health status and needs, and collaborate with clinical colleagues, supervisors, and Medical Directors to overcome care barriers. They must also identify and escalate member needs according to established guidelines and protocols, and actively reach out to members to guide their care.
Comprehensive pharmacy and healthcare services
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.