Schedule
Monday - Friday
8:00 AM - 5:00 PM Eastern Time
Position Summary
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 determinate needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.
Fundamental Components and Physical Requirements
- Acts as a liaison with member/client/family/employer, provider(s), insurance companies, and healthcare personnel as appropriate.
- Implements and coordinated 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 level of care.
- Interacts with members/ clients telephonically or in person. May be required to meet with members/clients in their homes, work sites, 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 instruction required by individual insurance carriers and referral sources.
- Testifies as required to substantiate any relevant case work or reports.
- Conducts and evaluation of members/ clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
- Utilizes care 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 members/clients' overall wellness through integration.
- Monitors member/clients progress toward desired outcomes through assessment and evaluation
Required Qualifications
- Candidate must have an active and unrestricted Compact License
- 3+ years clinical practice experience
- 2+ years case management, discharge planning, and/or home health care coordination experience
- Ability to occasionally travel up to 10% within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
- 2+ years proficiency with standard corporate software applications, including Microsoft Word, Teams, Excel, Outlook, and PowerPoint
Preferred Qualifications
- Experience working with Medicare members with diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), post-acute care, hospice, palliative care, and/or cardiac
- Managed care experience
- Willing and able to obtain additional state RN licenses (if needed)
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills
- Ability to work independently, remotely, and field based
- Efficient and effective computer skills including navigating multiple systems and keyboarding
Education
- Associate's Degree in Nursing (REQUIRED)
- Bachelor's Degree in Nursing (PREFERRED)
License
- Candidate must have an active and unrestricted New Jersey Registered Nurse (RN) Compact License
Anticipated Weekly Hours
40
Time Type
Full time
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.
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.