Case Manager Registered Nurse - Field in Mid-Cites (Forth Worth - Dallas) Texas

About the position At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Location Requirement: Mid-Cities, NE Forth Worth to NW DallasKeller, Grapevine, Euless, Coppell, N. Irving. Position SummaryThis position is work from home and will require travel for members for home, Long term Care Facilities and/or Group Home Visits. Roles and Responsibilities:Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.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 overall wellness through integration.Services strategies policies and programs are comprised of network management and clinical coverage policies.Coordinates and implements assigned care plan activities and monitors care plan progress.Conducts 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.Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Responsibilities

• Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.
• 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 overall wellness through integration.
• Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Conducts 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.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Resident of Texas Mid-Cities area: NE of Forth Worth to NW of Dallas
• Registered Nurse - Texas or Compact
• 3+ years clinical practice experience in Pediatrics
• 1+ year Case Management experience
• Must possess reliable transportation and be willing and able to travel up to 75% of the time. Mileage is reimbursed per our company expense reimbursement policy

Nice-to-haves

• MCO experience
• Star Kids experience
• Bilingual preferred in Spanish

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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