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CVS Accountable Care Hybrid Bilingual Field RN Case Manager Chicago, IL

at CVS Health in Springfield, Illinois, United States

Job Description

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary Requirement to reside in Chicago, Illinois, or within commuting distance of Chicago.50-75% of time will be spent in provider offices in Chicago.Working schedule is Monday-Friday; will work between 8am – 6pm EST.Fundamental Components & Physical Requirements:* Collaborates with the ACO provider partners in their office(s) to determine which beneficiaries would benefit most from case management services. Communicates with the provider partner(s) as to course of care and treatments as appropriate.* Acts in the role of embedded case manager within the provider partner(s) offices to meet with the beneficiaries in conjunction with their provider appointments.* Implements and coordinates all case management activities relating to catastrophic cases and chronically ill beneficiaries across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person in the provider partner(s) offices.* May be required to interact with beneficiaries via telephone, if unable to meet with the beneficiary during physician visits and to provide ongoing case management services.* Assesses and analyzes injured, acute, or chronically ill beneficiaries medical and/or vocational status; develops a plan of care to facilitate the beneficiaries appropriate condition management to optimize wellness and medical outcomes, aid in optimal functioning, and determination of eligibility for benefits as appropriate.* Communicates with beneficiary and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.* Prepares all required documentation of case work activities as appropriate.* Interacts, consults, and make appropriate referrals to/with internal multidisciplinary team as indicated to help beneficiary maximize best health outcomes.* Provides educational and prevention information for best medical outcomes.* Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by Medicare and referral sources.* Conducts an evaluation of beneficiaries needs and facilitates integrative functions using clinical tools and information/data.* Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function.

  • 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 beneficiary’s overall wellness through integration. Monitors beneficiary progress toward desired outcomes through assessment and evaluation.* Acts as a liaison with beneficiary, family, provider(s), and healthcare personnel as appropriate.* Prepares all required documentation of case work activities as appropriate. Required Qualifications Requirement to reside in Chicago Illinois, or within commuting distance of Chicago. A Registered Nurse that must hold an unrestricted license in their state of Ill
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Job Posting: JC248307473

Posted On: Sep 22, 2023

Updated On: Dec 14, 2023

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