About the position
The Case Manager RN position at CVS Health is a flexible work-from-home role that requires travel up to 50% for home visits in Denton, Collin, and Dallas County, TX. This position is integral to delivering quality healthcare services to members, focusing on developing, implementing, and promoting health service strategies, policies, and programs. The role demands advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral health services, ensuring that members receive comprehensive care tailored to their needs. As a Case Manager, you will be responsible for care planning, collaborating with providers, and utilizing available resources effectively and cost-efficiently. Strong assessment, writing, and communication skills are essential, as you will conduct face-to-face visits with members, utilizing comprehensive assessment tools for those enrolled in Long-Term Services and Support (LTSS) programs. You will coordinate care with members, their representatives, and the care team, ensuring that all services are in place for safe discharges and ongoing support. Your responsibilities will also include conducting thorough assessments of members' needs, identifying high-risk factors, and implementing care plans while monitoring their progress. You will use a holistic approach to enhance the quality of care, presenting cases at conferences for multidisciplinary review and utilizing negotiation skills to secure necessary services. The role emphasizes empowering members to engage in their healthcare decisions actively, promoting healthy lifestyle choices, and ensuring they have the support needed to achieve optimal health outcomes.
Responsibilities
- Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to members.
- Conduct face-to-face visits in members' homes using comprehensive assessment tools for those enrolled in Long-Term Services and Support programs.
- Coordinate and collaborate care with the member, authorized representative, PCP, and other care team participants.
- Schedule and attend interdisciplinary meetings, advocating for members to ensure proper and safe discharge with appropriate services in place.
- Develop care plans and authorize services in a cost-effective manner within the LTSS benefit.
- Document accurately and timely in the member's electronic health record.
- Conduct comprehensive evaluations of referred members' needs and recommend approaches to case resolution.
- Identify high-risk factors and service needs that may impact members' outcomes and care planning components.
- Utilize a holistic approach to overcome barriers to meet goals and objectives, presenting cases at case conferences for multidisciplinary review.
- Identify and escalate quality of care issues through established channels.
- Utilize negotiation skills to secure appropriate options and services necessary to meet members' healthcare needs.
- Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
Requirements
- Active and unrestricted RN license in the state of TX
- 2+ years of clinical experience
- Must reside in Denton, Collin, or Dallas County of TX
- Willing and able to travel up to 50% of their time to meet members face to face
- Reliable transportation required; mileage is reimbursed as per company policy
Nice-to-haves
- Case Management and/or home health care experience
- Managed care organization (MCO) experience
- Pediatric experience
Benefits
- Full range of medical, dental, and vision benefits
- 401(k) retirement savings plan
- Employee Stock Purchase Plan
- Fully-paid term life insurance
- Short-term and long-term disability benefits
- Well-being programs
- Education assistance
- Free development courses
- CVS store discount
- Paid Time Off (PTO) or vacation pay
- Paid holidays throughout the calendar year
