RN Case Manager REMOTE (Northern Region) CARDINAL Virtual Hiring Event

Click HERE to apply now!

Qualifying candidates may be eligible for a sign on bonus of up to $5,000.

This is a full time remote teleworker position in Virginia. The Case Manager RN (CM RN) is responsible for telephonically and/or face to face 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. 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 member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Travel is required; 25-40% of the time, in the Northern Winchester Region.

Fundamental Components:

• Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Typical office working environment with productivity and quality expectations
• Work requires the ability to perform close inspection of hand written and computer-generated documents as well as a PC monitor.
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written.

Required Qualifications

• Registered Nurse with current unrestricted Virginia (VA) license or Registered Nurse with current unrestricted VA ”multi-state privilege” license
• Minimum 1 year of related clinical nursing experience with medically complex members.
• 5 years clinical practice experience.
• Resides in VA; in the Northern Winchester region.
• Ability to travel with personal vehicle, 25-40% of the time. Must possess reliable transportation, active driver’s license, and proof of vehicle insurance.
• Demonstrated proficiency with personal computer, keyboard, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint

COVID Requirements

CVS Health requires its 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, or religious belief that prevents them from being vaccinated.

• If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
• If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

• Case management experience in an integrated model is preferred.
• Case Management (CCM) Certification is preferred.
• BSN degree is preferred.

Education

• Diploma RN or Associate degree in Nursing is acceptable.

Technical requirements

After signing up, you will be sent an email with instructions on how to connect.
Please be prepared to join the virtual interview from a quiet place using a desktop or mobile device with a working speaker, microphone, and camera. Check to see if your network connection can support an online session. A plugged in ethernet cable or a strong WiFi network signal will help avoid time delays during your conversation.

What to prepare

• Resume

Preferred dress code

Casual (come as you are, but please be presentable)

About Aetna, a CVS Health Company

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

What is a virtual interview?

Virtual interviews help employers connect with job seekers when they are not in the same physical location. Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.