Case Manager RN - Oncology or Transplant - Remote Case Management Opportunity with American Health Holding, Inc

Join the CVS Health Family as a Remote Case Manager RN - Oncology or Transplant

CVS Health is a leading healthcare company that is dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose is to bring our heart to every moment of your health, and we achieve this through our commitment to providing personalized, convenient, and affordable healthcare solutions. As a part of our team, you will have the opportunity to make a meaningful impact on the lives of our members and their families.

About American Health Holding, Inc (AHH)

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management, and Utilization Management. We deliver flexible medical management services that support cost-effective quality care for members.

Job Summary

We are seeking a highly skilled and compassionate Case Manager RN - Oncology or Transplant to join our team on a remote basis. As a Case Manager RN, you will work intensely with patients and their care teams to ensure that our members receive the best possible care. This is a unique opportunity to utilize your clinical expertise and case management skills to make a positive impact on the lives of our members.

Key Responsibilities:

• Conduct thorough assessments of patients' medical conditions, including co-morbid and multiple diagnoses, to develop comprehensive care plans.
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators that impact care planning and resolution of member issues.
• Collaborate with patients, families, and care teams to develop and implement individualized care plans that meet the unique needs of each member.
• Utilize motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
• Identify and escalate member needs appropriately following set guidelines and protocols.
• Perform medical necessity reviews and make recommendations for continued care.
• Consult with supervisors, Medical Directors, and other programs to overcome barriers to meeting goals and objectives.
• Maintain accurate and comprehensive records of patient interactions and care plans.

Requirements:

Essential Qualifications:

• 5+ years of experience as a Registered Nurse with hospital experience, preferably in Oncology or Transplant.
• A Registered Nurse that holds an unrestricted license in their state of residence, and is willing to obtain multi-state/compact privileges and can be licensed in all non-compact states.
• 1+ year of experience documenting electronically using keyboard and multiple computer screens, as well as free-form text with good typing skills.
• 1+ year of current or previous experience in Oncology or Transplant.
• Diploma or Associates Degree in Nursing or higher.

Preferred Qualifications:

• 1+ year of experience in Case Management or discharge planning, nurse navigator or nurse care coordinator experience, as well as experience with transferring patients to lower levels of care.
• 1+ year of experience in Utilization Review.
• CCM and/or other URAC recognized accreditation preferred.
• 1+ year of experience with MCG, NCCN, and/or Lexicomp.
• Bilingual, preferably Spanish.

Skills and Competencies:

To be successful in this role, you will need to possess the following skills and competencies:

• Excellent clinical and critical thinking skills.
• Strong communication and interpersonal skills.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Ability to prioritize and manage multiple cases simultaneously.
• Strong analytical and problem-solving skills.
• Ability to utilize electronic medical records and other software applications.

Career Growth Opportunities and Learning Benefits:

At CVS Health, we are committed to the growth and development of our employees. We offer a range of learning and development opportunities, including:

• Comprehensive training programs.
• Tuition reimbursement and education assistance.
• Leadership development programs.
• Cross-functional training opportunities.

Work Environment and Company Culture:

Our company culture is built on a foundation of respect, integrity, and compassion. We strive to create a work environment that is inclusive, supportive, and empowering. As a remote employee, you will have the flexibility to work from home and maintain a healthy work-life balance.

What We Offer:

• Competitive salary range: $54,095.60 - $116,760.80.
• Comprehensive benefits package, including medical, dental, and vision benefits.
• Eligibility to participate in our 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Paid Time Off (PTO) and paid holidays.
• Opportunities for career growth and professional development.

How to Apply:

If you are a motivated and compassionate RN looking for a challenging and rewarding role, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to be considered for this position.

Don't miss this opportunity to join our team and make a difference in the lives of our members. Apply today!