Job Description
This is a telework role. Applicants should reside within a commutable distance to Tampa or Miami.
This is a remote based role, however there is 10%-20% travel on a monthly basis to visit members.
Schedule is Monday-Friday, Standard business hours.
Position Summary :
The 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.
Candidate must be located in FL.
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.
• 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
Required Qualifications
- RN with current unrestricted Florida state licensure required
- 3+ years clinical practice experience required
- 1+ year of experience in either Pediatrics, NICU or OB setting required
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
CVS Health
Tampa Florida
United States
Healthcare - Nursing
(No Timezone Provided)
Job Description
This is a telework role. Applicants should reside within a commutable distance to Tampa or Miami.
This is a remote based role, however there is 10%-20% travel on a monthly basis to visit members.
Schedule is Monday-Friday, Standard business hours.
Position Summary :
The 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.
Candidate must be located in FL.
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.
• 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
Required Qualifications
- RN with current unrestricted Florida state licensure required
- 3+ years clinical practice experience required
- 1+ year of experience in either Pediatrics, NICU or OB setting required
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.