Case Manager, Registered Nurse - Behavioral Health

zation Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

• This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients

• Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues

• Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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

• Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives

• Utilizes case management processes in compliance with regulatory and company policies and procedures

• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations

• Identifies and escalates member's needs appropriately following set guidelines and protocols

• Need to actively reach out to members to collaborate/guide their care

• Perform medical necessity reviewsRequired Qualifications

• 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting

• A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states

• 1+ years' current or previous experience in Behavioral Health

• 1+ years' experience documenting electronically using a keyboardPreferred Qualifications

• 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care

• 1+ years' experience in Utilization Review

• CCM and/or other URAC recognized accreditation preferred

• 1+ years' experience with MCG, NCCN and/or Lexicomp

• Bilingual in Spanish preferredEducation

• Diploma or Associates Degree in Nursing required

• BSN preferredAnticipated Weekly Hours
  40Time Type
  Full timePay Range

The typical pay range for this role is:$54,095.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 04/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.