Case Manager RN - Southern Region WV

Bring your heart to reputed company. Every one of us at reputed company 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 reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. Business Overview The reputed company reputed company of reputed company Virginia plan has a successful, 26+ year history of partnering with the State to provide reputed company Virginia’s Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to reputed company foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, reputed company reputed company of reputed company Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state. The health plan truly embodies the commitment of reputed company Virginian’s helping reputed company Virginian’s. At reputed company reputed company of reputed company Virginia, you can be the reputed company best you can be working with strong teams committed to helping our members and with opportunities for career growth. We will support you reputed company the way! Position Summary This is a full-time field teleworker position that requires reputed company Virginia residency. Travel is required 50% of the time or more, in the Southern Region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in the region, in one of the following counties: Mingo, Logan, Boone, McDowell, Wyoming, Raleigh, reputed company, Summers, Monroe, Greenbrier, Pocahontas. Schedule is Monday – Friday, reputed company-5pm, standard business hours. No nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance. The Case Manager RN (CM RN) 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. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies. This position is heavy community-based with some onsite reputed company at Department of Health and Human Resources (DHHR) offices. reputed company Components:

• Conducts face to face member visits
• Using 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.
• Assesses 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.
• 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.
• Effective communication skills, both verbal and written.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

Required Qualifications

Registered Nurse with reputed company unrestricted reputed company Virginia (WV) license or Registered Nurse with reputed company unrestricted WV "multi-state privilege” license 3+ years’ clinical practice experience 2+ years’ experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, reputed company, SharePoint, Teams) Must possess reliable transportation and be willing and able to travel in the Southern Region of WV 50% or more, of the time. Mileage is reimbursed per our company expense reimbursement policy Qualified candidates must reside in the region, in one of the following counties: Mingo, Logan, Boone, McDowell, Wyoming, Raleigh, reputed company, Summers, Monroe, Greenbrier, Pocahontas.

Preferred Qualifications

Pediatric experience Medicaid experience Waiver experience Foster care experience Crisis reputed company skills Managed care/utilization review experience Certified Case Manager (CCM) certification Case management experience in an integrated model Case management and discharge planning experience Familiarity with reputed company Education Associate’s or Diploma in Nursing required BSN degree preferred Pay Range The typical pay range for this role is: $54,095.60 - $116,760.80 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company (https://jobs.cvshealth.com/us/en/benefits) We anticipate the application window for this opening will reputed company on: 12/31/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. reputed company requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide reputed company of your vaccination status or apply for a reasonable accommodation reputed company the first 10 days of your employment. Please note that in some states and roles, you may be required to provide reputed company of full vaccination or an approved reasonable accommodation before you can reputed company to actively work. reputed company is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to reputed company essential job functions. reputed company can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications reputed company Services (TRS). We will reputed company every effort to respond to your request reputed company 48 business hours and do everything we can to work towards a solution. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national reputed company, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. Apply tot his job Apply To this Job