Case Manager RN - Field (Mercer County, NJ)

About the role

At CVS Health, we're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. 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.

This is a work from home flexible position with 25-50% travel in Mercer County, New Jersey. Travel will be up to a 50 mile radius from your home. Standard working hours are Monday – Friday, 8-5 pm.

Responsibilities

• Assess, plan, implement, and coordinate all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness
• Develop a proactive plan of care to address identified issues to enhance short and long-term outcomes as well as opportunities to enhance a member's overall wellness
• Use clinical tools and information/data review to conduct an evaluation of member's needs and benefits
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning
• Conduct assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
• Use a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
• Collaborate with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives
• Present cases at interdisciplinary case conferences
• Utilize case management processes in compliance with regulatory and company policies and procedures
• Utilize motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Required qualifications

• Minimum 3+ years of clinical practice experience
• Must have active and unrestricted RN license in the state of NJ
• Willing and able to travel 25-50% of their time using your own vehicle to meet members face to face in their assigned area. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy
• Must reside in Mercer or surrounding County, NJ

Preferred qualifications

• Certified Case Manager is preferred
• Behavioral Health experience is strongly preferred
• Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
• Bilingual Preferred

Education

Associate's Degree in Nursing required. Bachelor's Degree preferred.

Schedule

Anticipated Weekly Hours: 40. Time Type: Full time.

Pay

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.

Benefits

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. Benefits 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.