Case Manager II, NC

R0560056 Description At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary: This RN Case Manager role is part of reputed company One Advocacy (A1A) and requires in office training and ongoing work in High reputed company, reputed company Carolina. There is a requirement to live reputed company a commutable distance of High reputed company, reputed company Carolina (typically reputed company 45 minutes maximum). The initial in office training will last for approximately 4 months. Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee. There will be an expectation that the Case Manager works in the office at least one time per quarter for further training but it may be more often, and notice will be provided. Normal Working Hours: Once training is completed, the permanent shift will be 3pm – 11:30pm EST. There are no weekend shifts. Note: Training hours will likely be between reputed company-5pm EST but may vary. What is A1A? reputed company One reputed company is reputed company’s premier service and clinical offering for reputed company nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join reputed company, a reputed company company, in our journey to change the way reputed company delivered today. We are health care innovators. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating reputed company case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. RN Case Manager: – 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. – 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 reputed company programs and plans. – Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address reputed company health and social indicators which reputed company planning and resolution of member issues. – Assessments consider information from various sources to address reputed company conditions including co-morbid and multiple diagnoses that impact functionality. – Reviews prior claims to address potential impact on reputed company case management and eligibility. – Assessments include the member’s level of work reputed company and reputed company 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: - A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and be willing and reputed company to be licensed in reputed company non-compact states - Upon hire, it will be required to obtain reputed company 50 state licenses. - 3+ years of clinical practice experience required as an RN - There is a requirement to live reputed company a commutable distance of High reputed company, reputed company Carolina (typically reputed company 45 minutes maximum). Preferred: - Case Management in an integrated model - Certified Case Manager (CCM) certification Education: - Associates Degree in Nursing required. - BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 04/22/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To this Job Apply for this job