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CVS Health Case Manager RN in Lenexa, Kansas

Job Description

This is a full-time telework role open to candidates who live in Kansas.Candidate must reside in Kansas (Central, Topeka, Northeast, Eastern KS) The role will require 50-75% travel in assigned regions.Schedule is Monday-Friday, standard business hours.The dedication of talented and caring health care professionals drives thedelivery of high quality, cost effective products and services. They make itpossible for members to get the right health care treatment for their needs– and for Aetna to keep its competitive edge.Facilitate the delivery of appropriate benefits and/or healthcare informationwhich determines eligibility for benefits while promoting wellness activities.Develops, implements and supports Health Strategies, tactics, policies andprograms that ensure the delivery of benefits and to establish overallmember wellness and successful and timely return to work. Services andstrategies, policies and programs are comprised of network management,clinical coverage, and policies.Nurse Case Manager is responsible for telephonically and/or face to faceassessing, planning, implementing and coordinating all case managementactivities with members to evaluate the medical needs of the member tofacilitate the member’s overall wellness. Develops a proactive course ofaction to address issues presented to enhance the short and long-termoutcomes as well as opportunities to enhance a member’s overall wellnessthrough integration. Services strategies policies and programs arecomprised of network management and clinical coverage policies.Through the use of clinical tools and information/data review, conducts anevaluation of member's needs and benefit plan eligibility and facilitatesintegrative functions as well as smooth transition to Aetna programs andplans. Applies clinical judgment to the incorporation of strategies designedto reduce risk factors and barriers and address complex health and socialindicators which impact care planning and resolution of member issues.Assessments take into account information from various sources to addressall conditions including co-morbid and multiple diagnoses that impactfunctionality. Reviews prior claims to address potential impact on currentcase management and eligibility. Assessments include the member’s level ofwork capacity and related restrictions/limitations. Using a holistic approachassess the need for a referral to clinical resources for assistance indetermining functionality. Consults with supervisor and others inovercoming barriers in meeting goals and objectives, presents cases atcase conferences for multidisciplinary focus to benefit overall claimmanagement. Utilizes case management processes in compliance withregulatory and company policies and procedures. Utilizes interviewing skillsto ensure maximum member engagement and discern their health statusand health needs based on key questions and conversation.

Required Qualifications

-Registered Nurse with current unrestricted licensure in Kansas.-3+ years clinical practice experience

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.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Case Management in an integrated model preferredBilingual preferredExperience with chronic conditions or behavioral health


RN with current unrestricted state licensure required.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

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.