Case Manager Registered Nurse - Field (Wayne and Macomb counties)

CVS HealthWarren, MI, US

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Case Manager Registered Nurse

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This role will be 25-50% travel within Wayne or Macomb County. This is a work from home position with field based responsibilities.

Position Summary : Help us elevate our patient care to a whole new level! Schedule : Standard business hours - 8 : 00AM-5 : 00PM, no night, weekend or holiday shifts! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.

Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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.

Responsibilities :

Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness.
Uses clinical tools and information / data review to conduct an evaluation of member's needs and benefits.
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications :

Minimum 3+ years clinical practical experience as a Registered Nurse

Must have active and unrestricted Michigan Registered Nurse licensure

Must be willing and able to travel up to 25%- 50% of the time in Wayne and Macomb Counties. Mileage is reimbursed per our company expense reimbursement policy

Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint

Effective computer skills including navigating multiple systems and keyboarding

Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually

Excellent analytical and problem-solving skills

Effective communications, organizational, and interpersonal skills

Ability to work independently

Preferred Qualifications :

2+ years of experience in case management, discharge planning and / or home health care coordination experience

Behavioral health experience

Bilingual in Spanish or Arabic

Certified Case Manager

Education :

Associate's Degree required

Bachelor's degree preferred

Business Overview :

At Aetna, a CVS Health company, we are joined in a common purpose : helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : $60,522.00 - $129,615.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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Registered Nurse Case Manager • Warren, MI, US