Hybrid RN Case Manager

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Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary
$3,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS.

Requirement to reside on Long Island, New York, or within commuting distance of Long Island.

50-75% of time will be spent in provider offices or beneficiaries home visit Long Island, NY.

Working schedule is Monday-Friday; will work between 8am – 6pm EST.

The Hybrid Case Manager works in the field in provider offices, skilled nursing facilities, hospitals, or beneficiary’s homes, using a collaborative process of coordination of care, assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Fundamental Components & Physical Requirements:
* Collaborates with the ACO provider partners in their office(s) to determine which beneficiaries would benefit most from case management services. Communicates with the provider partner(s) as to course of care and treatments as appropriate.

Can act in the role of embedded case manager within the provider partner(s) offices to meet with the beneficiaries in conjunction with their provider appointments.

Can at in the role of care coordinator and clinical team liaison as beneficiaries are preparing for facility discharges.

* Acts in the role of embedded case manager within the provider partner(s) offices to meet with the beneficiaries in conjunction with their provider appointments.
* Implements and coordinates all case management activities relating to catastrophic cases and chronically ill beneficiaries across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person in the provider partner(s) offices.
* May be required to interact with beneficiaries via telephone, if unable to meet with the beneficiary during physician visits and to provide ongoing case management services.
* Assesses and analyzes injured, acute, or chronically ill beneficiaries medical and/or vocational status; develops a plan of care to facilitate the beneficiaries appropriate condition management to optimize wellness and medical outcomes, aid in optimal functioning, and determination of eligibility for benefits as appropriate.
* Communicates with beneficiary 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, consults, and make appropriate referrals to/with internal multidisciplinary team as indicated to help beneficiary maximize best health outcomes.
* 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 instructions required by Medicare and referral sources.
* Conducts an evaluation of beneficiaries needs and facilitates integrative functions using clinical tools and information/data.
* Utilizes case 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.                                                 

*  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 beneficiary’s overall wellness through integration. Monitors beneficiary progress toward desired outcomes through assessment and evaluation.
* Acts as a liaison with beneficiary, family, provider(s), and healthcare personnel as appropriate.
* Prepares all required documentation of case work activities as appropriate.

Required Qualifications
Requirement to reside in Long Island, New York, or within commuting distance of Long Island, NY.

A Registered Nurse that must hold an unrestricted license in their state, New York of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states. 

3+ years clinical nursing experience required with at least 1 year of experience in one of the following areas: critical care, ICU, CCU, Emergency

2+ years case management experience

Must be willing to travel up to 75% throughout various areas of Long Island.

Reliable transportation required

Mileage is reimbursed per our company expense reimbursement policy

Depending on requirements of provider offices, certain vaccines (i.e., COVID, Flu) may be a requirement of the role, as well as additional health screenings (i.e., drug screen, vaccine titers).

Preferred Qualifications
Managed Care experience
Medicare experience

Experience working in health care provider office setting
Advanced Care Planning Experience
CCM Certification
Excellent analytic and problem-solving skills
Ability to work independently (this position will be field work and work from home)
Effective computer skills including navigating multiple systems and keyboarding
Bilingual Spanish and English

Education Associate degree minimum as registered Nurse.
 

Pay Range

The typical pay range for this role is:

$54,095.60 – $116,800.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/30/2024

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.