Job Description:

• Telephonically and/or face to face assess, plan, implement, and coordinate case management activities
• Evaluate members' medical needs within a NICU/high-risk maternity case management program
• Facilitate members' overall wellness and manage all aspects of their NICU and/or maternity journey
• Develop proactive courses of action to address issues and improve short- and long-term outcomes
• Evaluate member needs, benefit plan eligibility, and transitions to Aetna programs and plans using clinical tools and data review
• 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 or limitations
• Review prior claims for potential impact on case management and eligibility
• Refer members to clinical resources when needed
• Consult with supervisors and colleagues to overcome barriers and present cases at multidisciplinary case conferences
• Use case management processes in compliance with regulatory and company policies
• Conduct interviews to maximize member engagement and determine health status and needs

Requirements:

• Must hold an active and unrestricted RN License
• Must be willing and able to pursue multi-state licensure
• Minimum of 3+ years of clinical experience as an RN in a NICU setting
• Preferred RN licensure in a compact state
• Clinical experience as an RN in an inpatient or outpatient setting focused on women's health, Infertility, maternity and/or OB-GYN office setting
• 1+ years of Case Management experience in an integrated model
• 1+ years of experience with Telephonic Case Management
• Experience with Microsoft Office, including PowerPoint, Excel, and Word
• Certified Case Manager (CCM) certification
• Experience with ATV/ASD
• Associates Degree Nursing
• Direct/hardwired internet connection to a modem/router within 7 feet of the computer
• Minimum internet speed of 25 mbs download and 3 mbs upload
• Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
• Ability to work within the state and city where currently living
• Ability to use multiple monitors and navigate multiple applications simultaneously
• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
• Experience with Microsoft Office 365 applications or similar (Google Workspace)
• Ability to access secure systems such as VPN and EHR portals, maintain strong passwords, and recognize suspicious emails or links
• Ability to resolve common technical issues independently
• Openness to learning new skills as the workplace evolves

Benefits:

• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Company-paid multi-state licensure
• Company-provided equipment (keyboard, monitor, computer, headset, etc.)