CVS Health Jobs

Community Care Case ManagerHelp 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's 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 outcomes.

Additional responsibilities to include but not limited to the following:

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.

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 services.

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 appropriate.

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 medical outcomes.

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 reports.

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 through integration.

Monitors member/client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

Candidate must have active and unrestricted Connecticut (CT) Registered Nurse (RN) License

Candidate must be willing to travel 55-75% within designated areas (Yale New Haven)

3

• years clinical practical experience p

reference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members

2

Preferred Qualifications

Excellent analytical and problem-solving skills

Effective communications, organizational, and interpersonal skills

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

Certified Case Manager

National professional certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

Associate's Degree in Nursing or Nursing Diploma (REQUIRED)

Bachelor of Science in Nursing (PREFERRED)

License:

Active and unrestricted Connecticut (CT) Registered Nurse (RN) License

Anticipated Weekly

Hours

40

Time Type: Full time

Pay Range

The typical pay range for this role is: $66,575.00 - $142,576.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.