Nurse

• Telephonically and/or face to face assess, plan, implement, and coordinate case management activities with members
• Evaluate members’ medical needs to facilitate overall wellness
• Develop proactive courses of action addressing issues and enhancing short- and long-term outcomes
• Use clinical tools and information/data review to evaluate member needs and benefit plan eligibility
• Facilitate integrative functions and smooth transitions to Aetna programs and plans
• Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators
• Assess co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions/limitations
• Review prior claims for potential impact on current case management and eligibility
• Assess the need for referrals to clinical resources
• Consult with supervisors and others to overcome barriers and present cases at multidisciplinary case conferences
• Use case management processes in compliance with regulatory and company policies and procedures
• Utilize motivational interviewing skills to maximize member engagement and discern health status

Explore Care Manager – Registered Nurse at CVS Health. Review requirements and application details.

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