Clinical Case Manager, RN Field, CVS Health

Clinical Case Manager, RN Field

CVS Health

Location:

United States, Miami

Category:

Nursing

Contract Type:

Employment contract

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

The Care Manager RN is responsible for supporting care management activities across the continuum of care for a Medicaid population in Dade and Monroe Counties, FL. Responsibilities include assessment, care planning, provider collaboration, and psychosocial wraparound services to optimize outcomes.

Job Responsibility:

Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans
Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers
Handles reviews of prior claims to address potential impact on current case management and eligibility
Creates a holistic approach to assess the need for referrals to clinical resources and determining functionality
Ensures case management processes follow organization and regulatory requirements
Implements systems to maximize member engagement, discern health status and needs
Coaches and trains junior colleagues in techniques, processes, and responsibilities

Requirements:

Must reside in Miami Dade, FL or a surrounding county
Bilingual in Creole and/or Spanish
Active current unrestricted RN licensure in the state of Florida
3+ years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Willing and able to travel 10-20% of their time to meet members face to face in the Miami Dade County and surrounding areas
Reliable transportation required
2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications
using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Nice to have:

Chronic disease management preferred (cancer, diabetes, hypertension, chronic kidney disease, serious mental illness, and/or HIV aids)
Case management in an integrated model preferred
Managed care experience
Discharge planning experience
Experience providing care to the Medicaid population

What we offer:

Medical, dental, and vision benefits
401(k) retirement savings plan
Employee Stock Purchase Plan
Term life insurance plan
Short-term and long term disability benefits
Well-being programs
Education assistance
Free development courses
CVS store discount
Discount programs with participating partners
Paid Time Off (PTO)
Paid holidays

Additional Information:

Job Posted:

March 19, 2025

Expiration:

April 30, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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