Full-Time

Case Manager RN-Field

Posted on 9/20/2024

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare
Consumer Goods

Compensation Overview

$66.6k - $142.6kAnnually

+ Bonus + Commission + Short-term Incentive Program

Mid, Senior

Company Historically Provides H1B Sponsorship

Illinois, USA

Up to 40% travel expected in Winnebago, Boone, McHenry, Kendall, Grundy, LaSalle, DeKalb counties and surrounding areas.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Required Skills
Management
Requirements
  • Registered Nurse with active Illinois state license
  • Must reside in Illinois
  • Minimum 3+ years clinical practical experience as an RN
  • 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
  • Must possess reliable transportation and be willing and able to travel up to 40% of the time in Winnebago County, Boone County, McHenry County, Kendall County, Grundy County, LaSalle County, DeKalb County, and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.
Responsibilities
  • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
  • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
  • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
  • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
  • Communicates with member/client and other stakeholders as appropriate
  • Prepares all required documentation of case work activities as appropriate.
  • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
  • May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
  • Provides educational and prevention information for best medical outcomes.
  • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
  • Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
  • Utilizes case management processes in compliance with regulatory and company policies and procedures.
  • Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
  • 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/client’s overall wellness through integration.
  • Monitors member/client progress toward desired outcomes through assessment and evaluation.

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 pharmacies offer prescription medications, over-the-counter health products, beauty items, and general merchandise. CVS Health also includes a pharmacy benefits manager that serves over 75 million plan members and a senior pharmacy care business that assists more than one million patients each year. This integrated model 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 supporting individuals on their journey to better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

Growth & Insights
Headcount

6 month growth

0%

1 year growth

0%

2 year growth

0%
Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of at-home health testing kits presents a significant growth opportunity for CVS.
  • Maintaining free cash-back services could differentiate CVS from other retailers.
  • Growing market for accessible hearing solutions offers CVS a chance to expand product offerings.

What critics are saying

  • At-home health tests may reduce in-store visits, impacting CVS's foot traffic.
  • Fees for cash-back transactions could lead to customer dissatisfaction if adopted by CVS.
  • Increased competition in OTC hearing aids may challenge CVS's market share.

What makes CVS Pharmacy unique

  • CVS offers a comprehensive range of health services and products under one roof.
  • The company has a strong pharmacy benefits management with over 75 million plan members.
  • CVS's extensive retail network includes 9,600 pharmacies and 1,100 walk-in clinics.

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