Full-Time

Case Manager RN

Posted on 11/26/2024

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare
Consumer Goods

Compensation Overview

$54.1k - $116.8kAnnually

+ Bonus + Commission + Short-term Incentive Program

Entry, Junior

Company Historically Provides H1B Sponsorship

Phoenix, AZ, USA

Work from home with travel required in Maricopa County, Arizona.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • Must reside in Maricopa County, AZ
  • Active and unrestricted RN license in the state of Arizona.
  • Willing and able to travel 50% of their time to meet members face to face within Maricopa County AZ and surrounding areas. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
  • 2+ years clinical experience as a RN
  • 2+ years of case management, discharge planning, and/or home healthcare experience
Responsibilities
  • Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
  • Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources.
  • Conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
  • Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
  • Coordinates and implements assigned care plan activities and monitors care plan progress.
  • Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
  • Identifies and escalates quality of care issues through established channels.
  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.
  • Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

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 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, positioning itself as a significant player in the healthcare sector with a commitment to enhancing people's health.

Company Stage

N/A

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

N/A

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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