CVS Health
Chantilly, Virginia, United States
CCC+ Case Manager RN Registered Nurse
Posted over 1 month ago
Job 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 members 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 members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
This role is work at home following an initial one week of training in Chantilly, VA.25-50% of travel around Northern Virginia is required.
Please note that this position will require routine and frequent field-based travel to member locations.
Standard business hours Monday-Friday 8am-5pm are required.
* 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 members level of work capacity and related restrictions/limitations.
* Uses 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
* An active and good standing RN Virginia license is required
* Minimum of 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care) required.
* Must have the ability to support the complexity of members' needs, including face-to-face visitation. Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required
* Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required
* Strong documentation skills required
* Ability to work both independently and as part of a team required
* Strong written and verbal communication skills required.
* Strong organizational skills required.
* Ability to travel in the field required (25-50% local field travel).
* Unrestricted Virginia Driver's License
Preferred Qualifications
* Case management and discharge planning experience preferred
* Managed Care experience preferred
* Crisis intervention skills preferred
* Knowledge of community resources and provider networks preferred- Familiarity with local health care delivery systems preferred- Behavioral Health experience preferred
* Previous experience conducting face-to-face care management is preferred-Medicaid or CCC+ experience preferred
Education
Bachelor's degree or equivalent experience
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.
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 members 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 members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
This role is work at home following an initial one week of training in Chantilly, VA.25-50% of travel around Northern Virginia is required.
Please note that this position will require routine and frequent field-based travel to member locations.
Standard business hours Monday-Friday 8am-5pm are required.
* 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 members level of work capacity and related restrictions/limitations.
* Uses 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
* An active and good standing RN Virginia license is required
* Minimum of 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care) required.
* Must have the ability to support the complexity of members' needs, including face-to-face visitation. Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required
* Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required
* Strong documentation skills required
* Ability to work both independently and as part of a team required
* Strong written and verbal communication skills required.
* Strong organizational skills required.
* Ability to travel in the field required (25-50% local field travel).
* Unrestricted Virginia Driver's License
Preferred Qualifications
* Case management and discharge planning experience preferred
* Managed Care experience preferred
* Crisis intervention skills preferred
* Knowledge of community resources and provider networks preferred- Familiarity with local health care delivery systems preferred- Behavioral Health experience preferred
* Previous experience conducting face-to-face care management is preferred-Medicaid or CCC+ experience preferred
Education
Bachelor's degree or equivalent experience
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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