Case Manager RN CVS Health - Jacksonville, FL
Company: CVS Health
Posted on: January 16, 2022
Help us elevate our patient care to a whole new level! Join our
Community Care team as an industry leader in serving our members by
utilizing best-in-class operating and clinical models. You can have
life-changing impact on our Community Care members. Community Care
is a member centric, team-delivered, community-based care
management model that joins members where they are. 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
to change lives in new markets across the country.
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.
Community Care Case Manager use a collaborative process of
assessment, planning, facilitation, care coordination, evaluation,
and advocacy for options and services to meet an individual's and
family's comprehensive health needs through communication and
available resources to promote quality, cost effective
- Acts as a liaison with member/client /family, employer,
provider(s), insurance companies, and healthcare personnel as
- Implements and coordinates all case management activities
relating to catastrophic cases and chronically ill members/clients
across the continuum of care that can include consultant referrals,
home care visits, the use of community resources, and alternative
levels of care.
- Interacts with members/clients telephonically or in person. May
be required to meet with members/clients in their homes, worksites,
or physician's office to provide ongoing case management
- Assesses and analyzes injured, acute, or chronically ill
members/clients medical and/or vocational status; develops a plan
of care to facilitate the member/client's appropriate condition
management to optimize wellness and medical outcomes, aid timely
return to work or optimal functioning, and determination of
eligibility for benefits as appropriate.
- Communicates with member/client and other stakeholders as
appropriate (e.g., medical providers, attorneys, employers and
insurance carriers) telephonically or in person.
- Prepares all required documentation of case work activities as
- Interacts and consults with internal multidisciplinary team as
indicated to help member/client maximize best health outcomes.
- May make outreach to treating physician or specialists
concerning course of care and treatment as appropriate.
- Provides educational and prevention information for best
- Applies all laws and regulations that apply to the provision of
rehabilitation services; applies all special instructions required
by individual insurance carriers and referral sources.
- Testifies as required to substantiate any relevant case work or
- Conducts an evaluation of members/clients' needs and benefit
plan eligibility and facilitates integrative functions using
clinical tools and information/data.
- Utilizes case management processes in compliance with
regulatory and company policies and procedures.
- Facilitates appropriate condition management, optimize overall
wellness and medical outcomes, appropriate and timely return to
baseline, and optimal function or return to work.
- 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/client's overall wellness
- Monitors member/client progress toward desired outcomes through
assessment and evaluation.
- Minimum 3+ years clinical practical experience preference:
(diabetes, CHF, CKD, post-acute care, hospice, palliative care,
cardiac) with Medicare members.
- Minimum 2+ years CM, discharge planning and/or home health care
- Registered Nurse with active state license in good standing
within the region where job duties are performed is required.
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully
vaccinated against COVID-19 (including any booster shots if
required), where allowable under the law, unless they are approved
for a reasonable accommodation based on disability, medical
condition, pregnancy, or religious belief that prevents them from
If you are vaccinated, you are required to have received at least
one COVID-19 shot prior to your first day of employment and to
provide proof of your vaccination status within the first 30 days
of your employment. For the two COVID-19 shot regimen, you will be
required to provide proof of your second COVID-19 shot within the
first 60 days of your employment. Failure to provide timely proof
of your COVID-19 vaccination status will result in the termination
of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical
condition, pregnancy, or religious belief, you will be required to
apply for a reasonable accommodation within the first 30 days of
your employment in order to remain employed with CVS Health. As a
part of this process, you will be required to provide information
or documentation about the reason you cannot be vaccinated. If your
request for an accommodation is not approved, then your employment
may be terminated.
- Bilingual preferred
- Certified Case Manager is preferred.
- Additional national professional certification (CRC, CDMS,
CRRN, COHN, or CCM) is preferred, but not required
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal
- Ability to work independently (may require working from
- Proficiency with standard corporate software applications,
including MS Word, Excel, Outlook and PowerPoint, as well as some
special proprietary applications.
- Efficient and Effective computer skills including navigating
multiple systems and keyboarding
- Willing and able to obtain multi state RN licenses if needed,
company will provide.
Associates degree with equivalent experience, applicant would be
required to obtain a bachelor's degree within 3-5 years as part of
role development, state licensing laws may apply
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
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
Keywords: CVS Health, Jacksonville , Case Manager RN CVS Health - Jacksonville, FL, Healthcare , Jacksonville, Florida
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