Care Manager RN (Remote) | (Remote)

Job Description – Care Manager RN (Remote)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

This is a full-time telework position.

Hours for this role are Monday-Friday 8a-5p in time zone of residence.

 

Position Summary

The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs – and for Aetna to keep its competitive edge. Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

The 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.

Fundamental Components

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.

Review 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 conversations.

Required Qualifications

  • Active and unrestricted RN licensure in state of residence
  • 5+ years of clinical experience

Preferred Qualifications

  • Case Management in an integrated model

Education

  • Associate’s Degree minimum

Pay Range

The typical pay range for this role is:

$58,760.00 – $125,840.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Top 10 Tips for Interview

  1. Keep your mind and body, relaxed.
  2. Never try to give a long answer to an interview question. Keep your answer short and effective.
  3. If you don’t know the answer to any question, do not try to mislead the interviewer because he knows everything. Here your answer should be just some simple words “Sorry Sir/Ma’am, I do not know the answer”.
  4. Your dress should be formal. The formal dress always leaves a good impact on the interviewer.
  5. Take permission from the interviewer before going inside the interview room by saying “May I come in Sir/Madam?”.
  6. Do not shake your leg and hand again and again.
  7. Your clothes should be neat and clean.
  8. If the interviewer asks the question in English/Hindi, you should answer in the same language. If you are not comfortable in that language, you should ask your interviewer “I am not comfortable in English/Hindi. Sir, Can I answer in ‘your comfortable language’”. Do not try to give the answer in which language you are not comfortable because in this situation. You would not be able to give your 100% in that language.
  9. How much time you will stay in the interview room, do not be out of focus. Your focus should be on the interviewer. Do not miss any single word out of what he would be asking. Because if you do so, you will need to listen to that question again. And trust me, guys. This is a very bad impact. So try to understand and listen to the question properly at once.
  10. Before leaving the room. You should say ‘Thank you to your interviewer’

Some rules which are followed in good companies by good employees. About what you should know so that you may easily adapt them, given below.

  1. Company always wants you to be on time and you should be.
  2. Take less leave from the office.
  3. Focus on your work and try to learn more.
  4. Speak from your work not for your mouth.
  5. Keep on trying to get new things from your seniors, regarding your profile.
  6. Raise your point but only then when you are 100% sure about your point.
  7. Never hurry because haste makes waste.
  8. For earning some extra points than others. Just play out of your comfort zone.
  9. Always respect your seniors.
  10. Learn from mistakes made by you and others and do not try to repeat them.

Some Common Interview Question You Could Be Asked

  1. Tell me about yourself describe yourself or give your introduction.
  2. Why are you leaving your current company?
  3. How will you take our company ahead from here with the help of your work?
  4. Are you comfortable with our company’s work timing?
  5. Why should we hire you for this position?
  6. How much do you expect as a salary?

Answers should be given below.

  1. Introduction:
  1. My name is ‘NAME’,
  2. I have done ‘QUALIFICATION’,
  3. I am from ‘Location’,
  4. Currently I am working in ‘Company Name’ “Ignore if fresher”
  5. My current position is ‘Position Name’ “Ignore if fresher”
  6. I am working on ‘Project Name’ “Ignore if fresher”

Why USA is a Good Place to Work on for Foreigners

  1. Money (Most Important Reason):

As we all know 99.99% people do jobs only because of money and in America (USA) the monthly average salary is $5500. A graph is given below to understand easily.

Countries USA Dolor Other Currencies
India 5500 429382
China 5500 36898
Nigeria 5500 2,305,710
Nepal 5500 700,393.10
Canada 5500 7,027.08
Pakistan 5500 1,201,750
Brazil 5500 27,920
Sri Lanka 5500 1,979,616

 

  1. Safety in USA:

If you live in America then you can say that you are one of those people in America who are the safest in this planet.

Apply Now For This Job