Case Manager Registered Nurse - Field in Central Dallas, TX

About the role

We're building a world of health around every individual. You'll be part of a team that cares deeply, innovates with purpose, holds ourselves accountable, and prioritizes safety and quality.

Key Functions

• Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members.
• Facilitate appropriate physical, behavioral health, psychosocial wrap around services.
• Conduct face-to-face visits in the member's home using comprehensive assessment tools for members enrolled in Long-Term Services and Support programs.
• Coordinate and collaborate care with the member/authorized representative, PCP, and any other care team participants.
• Schedule and attend interdisciplinary meetings and advocate on the member's behalf to ensure proper and safe discharge with appropriate services in place.
• Work with the member and care team to develop a care plan and authorize services in a cost-effective manner within the LTSS benefit.
• Document accurately and timely in the member's electronic health record.
• Use critical thinking skills and the ability to problem solve.

Assessment of Members

• Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs.
• Evaluate member’s benefit plan and available internal and external programs/services.
• Identify high-risk factors and service needs that may impact members’ outcome and care planning components with appropriate referrals.
• Coordinate and implement assigned care plan activities and monitor care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

• Overcome barriers to meet goals and objectives; present cases at case conferences to obtain multidisciplinary review.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Help the member actively and knowledgeably participate with their provider in healthcare decision-making.

Required Qualifications

• Active and unrestricted RN license in the state of TX.
• Minimum 2 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care.
• Must possess reliable transportation and be willing and able to travel up to 60% of the time.
• Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

• 1 year experience of Case Management.
• Managed care organization (MCO) experience.
• Pediatric experience.
• Star Kids experience.
• Bilingual preferred (Spanish).

Education

Associate degree required and BSN preferred.

Anticipated Weekly Hours

The typical weekly hours for this role are 40.

Pay Range

The typical pay range for this role is $60,522.00 - $129,615.00. 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.

Additional Information

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 belongs. Great benefits for great people. 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.