Case Manager Registered Nurse - Field In Northern Fort Worth

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

This is a work from home flexible position with expected travel of up to 60% that will require home visit to members in the assigned areas of Keller, Roanoke, Richland Hills, River Oaks, North of Fort Worth, TX. The schedule is Monday‑Friday, standard business hours, 8:00am-5:00pm CST.

Key Functions

• Develop, implement, support, and promote health service strategies, tactics, policies and programs that drive the delivery of quality health care to our members. These include utilization management, quality management, network management, clinical coverage and policies.
• Apply advanced clinical judgment and critical thinking to facilitate appropriate physical, behavioral health and psychosocial wrap‑around services.
• Responsible for care planning, direct provider collaboration and effective utilization of available resources in a cost‑effective manner.
• Strong assessment, writing and communication skills are required.
• Conduct face‑to‑face visits in members’ homes utilizing comprehensive assessment tools for members enrolled in Long‑Term Services and Support programs.
• Coordinate and collaborate care with the member/authorized representative, PCP and other care team participants.
• Schedule and attend interdisciplinary meetings, advocate on behalf of the member to ensure proper and safe discharge with appropriate services in place.
• Work with the member and care team to develop a care plan and authorize services in a cost‑effective manner within the LTSS benefit.
• Document accurately and timely in the member’s electronic health record.
• Use critical thinking skills and problem‑solving ability throughout the role.

Assessment of Members

• Use care‑management tools and data review to conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution.
• Identify high‑risk factors and service needs that may impact outcomes and incorporate them into care planning with appropriate referrals.
• Coordinate and implement assigned care plan activities and monitor progress.

Enhancement of Medical Appropriateness and Quality of Care

• Apply a holistic approach to overcome barriers to meet goals; present cases at conferences for multidisciplinary review to achieve optimal outcomes.
• Identify and elevate quality‑of‑care issues through established channels.
• Negotiate to secure appropriate options and services that meet the member’s benefits and healthcare needs.
• Use motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes.
• Provide coaching, information and support to empower members to make independent medical and lifestyle choices.
• Facilitate active participation of members with their providers in healthcare decision‑making.

Required Qualifications

• Active and unrestricted RN license in the state of TX.
• Minimum 2 years of clinical practice experience (e.g., hospital, home health or ambulatory care).
• Willing and able to travel up to 50% of time to meet members face‑to‑face in Dallas/Tarrant counties and surrounding areas.
• Reliable transportation; mileage reimbursed per company policy.

Preferred Qualifications

• 1 year of case‑management experience.
• Experience with a managed care organization (MCO).
• Experience with pediatric care.
• Experience with Star Kids.
• Bilingual preferred (Spanish).

Education

• Associate’s degree required; BSN preferred.

Other Details

Anticipated weekly hours: 40
Time type: Full time
Pay range: $60,522.00 – $129,615.00 (base hourly rate or annual salary). The actual base salary will depend on experience, education, geography and other factors. Eligible for bonus, commission or short‑term incentive program.

Benefits include medical, dental and vision coverage; paid time off; retirement savings options; wellness programs; and additional resources (based on eligibility). Qualified applicants with arrest or conviction records may be considered in accordance with all federal, state and local laws.

#J-18808-Ljbffr