Clinical Case Manager, RN Field - Bilingual - Orlando, FL

At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nations 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.

Position Summary

The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

The Case Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) for a Medicaid population in Dade and Monroe Counties, FL.

What you will do

Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.

Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.

Handles reviews of prior claims to address potential impact on current case management and eligibility.

Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.

Ensures case management processes follow organization and regulatory requirements.

Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.

Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Required Qualifications

• Must reside in Orange, Seminole, Brevard and Osceola Counties, FL or a surrounding county
• Active current unrestricted RN licensure in the state of Florida
• 3+ years clinical practice experience , e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• Willing and able to travel 10-20% of their time to meet members face to face in the Miami Dade County and surrounding areas. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
• 2+ years experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Preferred Qualifications

• Chronic disease management preferred (cancer, diabetes, hypertension, chronic kidney disease, serious mental illness, and/or HIV aids)
• Case management in an integrated model preferred
• Managed care experience
• Discharge planning experience
• Experience providing care to the Medicaid population
• Bilingual in Creole and/or Spanish

Education

• Associates degree or Diploma in Nursing required
• BSN preferred

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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 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.

For more information, visit

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