Case Manager Registered Nurse - Field In Northern Forth Smith

CVS Health Care Manager

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

This is a work from home flexible position with expected travel of up to 60% that will require home visit to members in the assigned areas of Keller, Roanoke, Richland Hills, River Oaks, North of Fort Worth, TX. Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.

Key Functions

• Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members.
• The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, psychosocial wrap around services.
• The care manager will be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner.
• Strong assessment, writing and communication skills are required.
• The Case Manager is responsible for conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Long-Term Services and Support programs.
• The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants.
• The case manager schedules and attends interdisciplinary meetings and advocates on the members behalf to ensure proper and safe discharge with appropriate services in place.
• The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the LTSS benefit.
• The care manager is responsible for documenting accurately and timely in the member's electronic health record.
• This position requires the case manager to use critical thinking skills and the ability to problem solve.

Assessment of Members

• Through the use of care management tools and information/data review, the Case Manager 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 members outcome and care planning components with appropriate referrals.
• Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

• 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 knowledgeably participate with their provider in healthcare decision-making.

Required Qualifications

• Active and unrestricted RN license in the state of TX.
• Minimum 2 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care.
• Willing and able to travel up to 50% of their time meet members face to face in Dallas/Tarrant counties of TX and surrounding counties/ areas.
• Reliable transportation required; mileage are reimbursed as per company policy.

Preferred Qualifications

• 1 year experience of Case Management.
• Managed care organization (MCO) experience.
• Pediatric experience
• Star Kids experience
• Bilingual preferred (Spanish)

Education

• Associate degree required and BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.