Complex Nurse Case Manager- Field- Must reside in Jefferson County, KY

Brief Overview

Coordinates all case management activities with members to evaluate medical needs and facilitate overall wellness. Develops strategy to address issues and enhance member's wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

What You Will Do

• Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to organization's programs and plans.
• Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and address complex health indicators impacting care planning and resolution of member issues.
• Creates a holistic approach to assess the need for referrals to clinical resources and assist in determining functionality.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Minimum Requirements

• Basic awareness of problem solving and decision making skills.
• Must reside in Jefferson County, KY.

Position Summary

The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in-person or telephonic contact to evaluate medical and psychosocial needs, facilitate and support improved health. Develops a proactive course of action to address issues, enhance short and long-term outcomes, and opportunities to enhance overall wellness. Services strategies, policies, and programs are comprised of network management and clinical coverage policies. Field-based position requiring 80-90% regional in-state travel using personal vehicle.

Evaluation of Members

• Conducts a comprehensive and holistic evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning and resolution of member issues.
• Field-based working environment with productivity and quality expectations.
• Requires the ability to perform close inspection of handwritten and computer-generated documents, sit for extended periods, talk on the telephone, and type on the computer.
• Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.

Qualifications

• 5+ years' clinical practice experience.
• RN with current unrestricted state licensure.
• Experience or detailed knowledge of Foster Care and juvenile justice systems, Adoption Assistance, Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to Kentucky SKY populations.
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required.
• Reliable transportation required (Mileage is reimbursed per our company expense reimbursement policy).
• MUST reside within Jefferson County, KY.

Preferred Qualifications

• Case Management experience in an integrated model.
• Bilingual preferred.
• Computer literacy and demonstrated proficiency in navigating internal/external computer systems, and MS Office Suite applications, including Word and Excel.
• Effective communication skills, both verbal and written.

Education

• Associate’s degree required.
• BSN preferred.

Pay Range

The typical pay range for this role is $54,095.00 - $116,760.00. 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.