CVS Health

Case Manager RN

Posted 1 day ago

Job Description

Job Description
This position requires the ability to travel in Arizona state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance. Travel will also be required to the Phoenix, AZ office up to once a month.

Nurse Case Manager is a full time teleworker position that requires some travel. This position 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.

At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. Were a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 were going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, lets work together to make a difference and improve the health and wellbeing of Arizona.

Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of people with complex needs and we need to be available around their schedule.

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.
* 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.
* 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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
* Typical office working environment with productivity and quality expectations.
* Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
* Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
* Multitasks, prioritizes and effectively adapts to a fast-paced changing environment.
* Demonstrates proficiency with computer skills which includes navigating multiple systems and keyboarding.
* Demonstrates effective communication skills, both verbal and written.

Required Qualifications
* RN with current unrestricted state licensure required.
* 5 years clinical practice experience.
* Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
* Must be Arizona based

Preferred Qualifications
Case Management in an integrated model preferred.
* Bilingual preferred.

Minimum of an Associates degree required
- BSN is preferred

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.