Hybrid Case Manager, RN

at CVS Health

• Job title: Case Manager, RN
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $72,627 - $155,538 per year
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Montclair, United States

About the role

• Aetna Care Manager working with dual eligible populations. Assessing and coordinating care to improve overall health for members in New Jersey with complex needs.

Responsibilities

• Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models.
• Assessing, planning, implementing, and coordinating 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 the 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, presents 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.

Requirements

• Minimum 3+ years of clinical practice experience
• Must have active and unrestricted RN licensure in the state of NJ
• Willing and able to travel 25-50% within Passaic County using your own vehicle to meet members face to face in their assigned area.
• Reliable transportation required.
• Certified Case Manager is 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 - Spanish.

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.