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ACO REACH Telephonic Case Manager RN - Case Management

Company: CVS Health
Location: Chicago
Posted on: November 19, 2023

Job Description:

ACO REACH Telephonic Case Manager RNJob Description

This is a full-time remote role with a requirement to reside in one of the following states: Florida, New York, or Illinois.

Working schedule is Monday-Friday; will work between 8am-8pm CST.

As part of the care coordination team, the ACO REACH RN Case Manager will be the primary care manager for a selected member population. The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members across the continuum of care. The RN Case Manager utilizes advance clinical judgement and critical thinking skills to effectively manage members through their illness with the goal of assuring the appropriate level of care is being provided, preventing Emergency Department visits and acute admissions, and ensuring the members physical, behavioral, and social needs are being appropriately addressed by the care team to achieve optimal clinical, financial, and quality of life outcomes.

Using clinical tools and information/data review, conducts an evaluation of member's needs and applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators to manage the chronic conditions of members.

Primary responsibilities include but not limited to the following:

* Serve as primary care manager for members identified for the Serious Illness program
* Telephonically engage members to complete a holistic assessment of current health status and work collaboratively with the care team to manage the member's most difficult symptoms and adaptation to their ongoing decline
* In collaboration with the multi-disciplinary team, develop and implement a care plan that addresses physical, behavioral and social needs
* Educate and assist member with advanced care planning, including establishing and end-of-life treatment plan
* Monitor and evaluate effectiveness of the care plan and modify plan in collaboration with multi-disciplinary team as necessary
* Work with treating physicians to develop anticipatory symptom management plan and monitor for new issues/concerns/changes in pace of illness
* Prepare member/caregiver to understand and identify signs of functional decline and discuss long term plan for managing to help avert medical emergencies
* Ensure safe and appropriate transitions of care by collaborating with hospital discharge planners, outpatient provider, family/caregivers and member, to ensure adequate caregiver assistance, functional support, medical follow up and medication oversight during transition from facility to home
* Make referrals to the Pharmacist for medication review and recommendations as indicated
* Make referrals to Social Worker and/or BH specialist as indicated

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

* An active and good standing RN in their state of residence
* 3+ years clinical 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 required

COVID Requirements

COVID-19 Vaccination Requirement

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.

Preferred Qualifications

* Managed Care experience preferred
* Medicare experience preferred
* Advanced Care Planning Experience preferred
* CCM Certification
* Excellent analytic and problem-solving skills
* Ability to work independently (this position will be work from home)
* Effective computer skills including navigating multiple systems and keyboarding


Associate degree minimum

RN with active/current unrestricted state licensure required in the state candidate resides in.

Business Overview

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.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Keywords: CVS Health, Chicago , ACO REACH Telephonic Case Manager RN - Case Management, Executive , Chicago, Illinois

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