Case Manager RN- Field
This is a full-time telework role open to candidates who live in Kansas. This position is embedded into hospitals.
Candidate must reside in Kansas. (East Central Kansas)
Highly prefers candidates residing in Wyandotte or Johnson County in KS or surrounding areas.
The role will require 75% + travel in assigned regions.
Schedule is Monday-Friday, standard business hours.
The dedication of talented and caring health care professionals drives the
delivery of high quality, cost effective products and services. They make it
possible for members to get the right health care treatment for their needs
– and for Aetna to keep its competitive edge.
Facilitate the delivery of appropriate benefits and/or healthcare information
which determines eligibility for benefits while promoting wellness activities.
Develops, implements and supports Health Strategies, tactics, policies and
programs that ensure the delivery of benefits and to establish overall
member wellness and successful and timely return to work. Services and
strategies, policies and programs are comprised of network management,
clinical coverage, and policies.
Nurse Case Manager 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.
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.
* In addition to the information above, this position will also be an embedded case manager in hospitals in the counties of Wyandot and in Kansas City Missouri with potential for expansion to other facilities in Wyandot or Johnson County.
The typical pay range for this role is:
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
-Active and Unrestricted RN licensure in the state of Kansas.
-Minimum 3 years of clinical experience as a nurse.
-Willing and able to travel 75% + of their time to meet members face to face in East Central KS and surrounding areas.
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.
-Case Management in an integrated model preferred
-Experience with chronic conditions.
- Experience working in hospital setting is strongly preferred.
Associate degree required and Bachelor's degree preferred.
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. 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.