Full-Time

Case Manager RN

Posted on 11/20/2024

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare

Compensation Overview

$54.1k - $116.8kAnnually

+ Bonus + Commission + Short-term Incentive Program

Junior, Mid

Company Historically Provides H1B Sponsorship

Advance, NC, USA + 3 more

More locations: Winston-Salem, NC, USA | High Point, NC, USA | Greensboro, NC, USA

Must live in North Carolina.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • Must have an active and unrestricted RN license in the state of North Carolina.
  • Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company)
  • 2+ years of clinical experience as an RN
  • All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.
  • Certified Case Manager (CCM) certification
  • 3+ years’ experience with Microsoft Office Suite
  • Case Management in an integrated model
  • Discharge Planning experience
  • Managed care experience
  • BSN
  • Associates Degree in Nursing
Responsibilities
  • 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.
  • 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.

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, beauty items, and general merchandise. CVS Health also functions as a pharmacy benefits manager, serving over 75 million plan members, and has a senior pharmacy care business that assists more than one million patients each year. This integrated approach allows CVS Health to deliver affordable health management solutions, improving access to quality care and health outcomes while aiming to reduce overall healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with clinical care and pharmacy benefits management, making it a significant player in the healthcare sector with a goal of helping individuals achieve better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

Growth & Insights
Headcount

6 month growth

-2%

1 year growth

-2%

2 year growth

-2%
Simplify Jobs

Simplify's Take

What believers are saying

  • The availability of updated flu and COVID-19 vaccines at CVS Pharmacy and MinuteClinic locations nationwide positions the company as a key player in public health initiatives.
  • The Health Zones funding and collaboration with local organizations in Fresno highlight CVS Pharmacy's role in improving community health outcomes.
  • The introduction of a new store brand for snacks, beverages, and groceries could attract a broader customer base and increase in-store sales.

What critics are saying

  • The competitive landscape in the retail pharmacy sector is intense, with major players like Walgreens and Rite Aid posing significant challenges.
  • The expansion into grocery and snack products may dilute CVS Pharmacy's brand identity as a healthcare provider.

What makes CVS Pharmacy unique

  • CVS Pharmacy's integration of digital tools for scheduling vaccinations and accepting walk-ins offers a seamless and convenient experience for customers, setting it apart from competitors.
  • The company's Health Zones initiative, which focuses on community health and access to healthy food, demonstrates a commitment to social responsibility that goes beyond traditional pharmacy services.
  • CVS Pharmacy's recent launch of a new store brand for snacks, beverages, and groceries diversifies its product offerings, making it a one-stop shop for consumers.

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