RN- Health Care (Full-Time

Position Responsibilities

Ensures safe and appropriate transition between settings by collaborating with identified points of contact at facilities, members, responsible parties, legal guardians, providers, and support networks through the interdisciplinary care team process.

Through the use of clinical tools and information/data review, conducts assessments of referred member's needs/eligibility and determines approach to meeting needs by evaluating available internal and external programs and services.

Analyzes utilization, self‑reported, and clinical data available to consolidate information and begins to identify comprehensive member needs.

Follows members through their inpatient admission and continues oversight through transition from the acute setting to all other settings with the goal of reducing readmissions and increasing permanency in the community.

Available to conduct face‑to‑face visits as necessary for high‑risk members.

Coordinate care and reassess member's needs as clinically indicated and per desktop and job aid requirements.

Ensures members transition upon discharge with adequate supervision, recommended behavioral health, physical health, maternity health, pharmacy resources, and care management support.

Educates and supports member/caregiver focusing on the seven primary areas: medication management, use of personal health record, follow‑up care, signs and symptoms of worsening condition, nutrition, functional needs and advance directives.

Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

Using advanced clinical skills, identifies crisis intervention with members experiencing a behavioral health, medical or maternity crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.

Provides crisis follow‑up to members to help ensure they are receiving the appropriate treatment/services.

Applies and/or interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.

Using a holistic approach consults with managers, medical directors and/or other program representatives as needed to overcome barriers to meeting goals and objectives.

Presents cases at case conferences/rounds to obtain a multidisciplinary view in order to achieve optimal outcomes.

Engages and builds continued professional relationships at network facilities.

Identifies and escalates quality of care issues through established channels.

Communicates and collaborates with medical and behavioral health professionals to influence appropriate member care.

Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.

Educational Requirements

Minimum Associate's or diploma in Nursing (required)

Bachelor's and/or Master's degree (preferred)

Required Requirements

Minimum Associate's or diploma nursing degree

3-5 years clinical practice experience (e.g., hospital, ambulatory care, or outpatient setting)

2+ years' experience using a personal computer, including:

Keyboard navigation

Navigating multiple systems and applications

MS Office Suite (Teams, Outlook, Word, Excel, etc.)

Strong customer service orientation and problem‑solving skills

Excellent motivational interviewing skills and ability to build rapport and trust telephonically

Excellent documentation skills and adherence to compliance/regulatory standards

Highly organized and self‑driven, able to work without direct supervision

Effective time management skills

Ability to achieve performance metrics

Strong technology proficiency

Flexibility with variable work schedules, including working 2 days weekly until 9pm local time

Ability to travel to surrounding counties

Preferred Requirements

Case management and discharge planning experience in an integrated model

Bachelor's and/or Master's degree

CCM (Certified Case Manager) certification

Previous experience in Managed Care

Maternal and neonatal (Maternity/NICU) experience

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.

Benefits

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.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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