Full-Time

Case Manager RN

Confirmed live in the last 24 hours

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

Mid

Company Historically Provides H1B Sponsorship

Greensboro, NC, USA

Field position based in Greensboro, NC.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • Minimum 3+ years clinical practical experience
  • Minimum 2+ years CM, discharge planning and/or home health care coordination experience
  • Active and unrestricted Compact RN in NC
  • Willing to travel 25% within Greensboro, NC
Responsibilities
  • 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.
  • This role is performed face-to-face/field-based and requires those in the position to travel at least 25% of the time outside of the home/office (e.g. acute care facility, nursing home, other facility).
  • 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

  • CVS offers at-home health testing kits, aligning with consumer demand for convenience.
  • The company provides free cash-back services, attracting customers amid rising fees elsewhere.
  • CVS's digital vaccine scheduler enhances customer convenience for flu and COVID-19 vaccinations.

What critics are saying

  • At-home testing kits may reduce in-store foot traffic for health services.
  • Sony's advanced hearing aids could challenge CVS's market share in this category.
  • Digital wallet trends may require CVS to update its payment systems.

What makes CVS Pharmacy unique

  • CVS Health offers a comprehensive pharmacy network with 9,600 retail locations.
  • The company integrates pharmacy benefits management with over 75 million plan members.
  • CVS Health provides specialty pharmacy services, enhancing its healthcare service offerings.

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