Case Manager RN-Remote-New York | Urgent Hiring

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every momen

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t 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.

 

Position Summary

This is a fully remote position. Qualified candidates must reside in the state of New York.

The dedication of talented and caring healthcare 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.

The Nurse Case Manager is responsible for telephonically 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. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators that 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.

Using a holistic approach to 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, present 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

-5+ years clinical practice experience

-Must have a current unrestricted RN licensure in the state of New York

-Must be a New York resident and have a New York Identification card

 

Preferred Qualifications

-Bilingual in English and Spanish preferred

 

Education

Associate degree required, bachelor’s degree preferred.

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