Position Summary: - The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Core Responsibilities: - Conducts comprehensive assessments of referred member's needs and eligibility through the use of clinical tools and information/data review. - Determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs and services. - Applies and interprets applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and member's needs to ensure appropriate administration of benefits. - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications: - RN with an unrestricted active license in New Jersey or a compact license in good standing with no history. - Minimum 3-5 years of clinical practical experience. - Ability to work independently. - Effective computer skills including navigating multiple systems and keyboarding. - Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as special proprietary applications. - Excellent analytical and problem-solving skills. - Effective communication, organizational, and interpersonal skills. - Confidence working at home as an independent thinker, using tools to collaborate and connect with teams virtually. Preferred Qualifications: - Minimum 2-3 years of Care Management, discharge planning, and/or home health care coordination experience. - Case Management Certification (CCM). - Experience with case management and IL waiver services.

RN Case Manager

Emma

Responsibilities

Skills wanted:

Language(s) required:

Vikas Jain

About CVS Health:

mission:

Job benefits for full-time members:

cvshealth.com/

Admin access needed