AddressBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
Shift is 8:30 am to 5 pm in your time zone
- This position consists of working intensely as a telephonic Case Manager with patients and their care team for fully and/or self-insured clients as well as having accreditation experience, primarily with NCQA
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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
- Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
- 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 conversations
- Identifies and escalates member’s needs appropriately following set guidelines and protocols
- Need to actively reach out to members to collaborate/guide their care
- Perform medical necessity reviews
Required Qualifications
- 5+ years’ experience as a Registered Nurse with hospital experience; preferably in the specialty
- 1 year Experience with accreditation process, primarily NCQA
- A Registered Nurse that holds an unrestricted license in their state of residence, with multi-state/compact privileges and can be licensed in all non-compact states
- 1+ years’ experience documenting electronically using keyboard and multiple computer screens as well as free form text with good typing skills
- 1+ years’ current or previous experience in Oncology, Behavioral Health/Substance Abuse, Transplant or Medical/Surgical
Preferred Qualifications
- 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
- CCM and/or other URAC recognized accreditation preferred
- 1+ years’ experience with MCG, NCCN and/or Lexicomp
Education
- Diploma or Associates Degree in Nursing or higher
Pay Range
The typical pay range for this role is:
$60,522.80 - $129,600.00This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
