Bilingual Registered Nurse Care Manager - Miami FL ID-23889
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
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Position Summary
The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CM RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.
The schedule for this position is Monday - Friday 8am-5pm EST, with a flex schedule options, working 4 days per week, the employee can select Tuesday, Wednesday, or Thursday as the flex day.
Position Responsibilities:
- Responsible for telephonic and face to face assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall wellness.
- Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member's overall health through integration.
- Through the use of clinical tools and information/data review, conducts comprehensive assessments of member's needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and addresses complex health and social indicators which impact care planning and resolution of member issues.
- Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member's restrictions and limitations.
- Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
- Provides crisis follow up to members to help ensure they are receiving the appropriate treatment and services.
- Applies and/or interprets applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member's needs to ensure appropriate administration of benefits.
- Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
- Using a holistic approach consults with manager, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
- Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.
- Works collaboratively with the members' interdisciplinary care team.
- Identifies and escalates quality of care issues through established channels.
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions andconversation.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
- Utilizes care management processes in compliance with regulatory and company policies and procedures.
- Facilitates clinical hand offs during transitions of care.
Required Qualifications
- Must reside in Miami Dade, FL or a surrounding county
- Bilingual in Spanish
- Active current unrestricted RN licensure in the state of Florida
- 3+ years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Willing and able to travel 10-20% of their time to meet members face to face in the Miami Dade County and surrounding areas. Reliable transportation required;Mileage is reimbursed per our company expense reimbursement policy
- 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
Preferred Qualifications
- Chronic disease management preferred (cancer, diabetes, hypertension, chronic kidney disease, serious mental illness, and/or HIV aids)
- Case management in an integrated model preferred
- Managed care experience
- Discharge planning experience
- Experience providing care to the Medicaid population
Education
- Associates degree or Diploma in Nursing required
- BSN preferred
