R0885307 Case Manager RN, Compact License - Remote

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. 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 determinate needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Fundamental Components and Physical Requirements Acts as a liaison with member/client/family/employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinated all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative level of care. Interacts with members/ clients telephonically or in person. May be required to meet with members/clients in their homes, work sites, or physician's office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g. medical providers, attorneys, employers, and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instruction required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. Conducts and evaluation of members/ clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes care management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a members/clients' overall wellness through integration. Monitors member/clients progress toward desired outcomes through assessment and evaluation Required Qualifications Candidate must reside in New Jersey Candidate must have an active and unrestricted New Jersey Registered Nurse (RN) Compact License 3+ years clinical practice experience 2+ years case management, discharge planning, and/or home health care