CVS Health Job - 40269050 | CareerArc
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Company: CVS Health
Location: Chicago, IL
Career Level: Mid-Senior Level
Industries: Retail, Wholesale, Apparel

Description

Job Description
Nurse Case Manager is responsible for telephonically and/or face to face 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. Develops a proactive course of
action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates
integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed
to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact
functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member's level of
work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in
determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim
management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills
to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications
Registered Nurse with unrestricted licensure in the state of IL required
3+ years clinical experience required

Preferred Qualifications
Previous Managed Care Organization experience
Experience working with individuals with both medical and behavioral health needs
Acute and/or Long Term Care experience preferred
CCM preferred

Education
Bachelor's Degree in Nursing 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.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


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