Job Description

This Case Manager RN role is with the Costco Team and is fully remote; however, candidates must reside within 45 minutes (reasonable driving distance) from the local office located at 7034 Alamo Downs Pkwy, San Antonio, TX 78238.

Travel to the San Antonio office may be required for quarterly meetings or PRN meetings.

Normal Working Hours : Monday through Friday 8 : 00am-5 : 00pm CST with flexibility to rotate to 10 : 00am-7 : 00pm CST on occasion when required to meet business needs.

No weekends or holidays will be required.

The Case Manager RN is responsible for telephonically and / or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

The Case Manager RN develops a proactive course of action to address issues presented to enhance the short- and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.

The Case Manager RN job duties include (not an all-encompassing list) :

• Through the use of clinical tools and information / data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• 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 consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's level of work capacity and related restrictions / limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining 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.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Pay Range

The typical pay range for this role is :

Minimum : 58,760

Maximum : 125,840

This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

jobs.CVSHealth.com / benefits

Required Qualifications

• Willingness to obtain additional state licenses will be required upon hire (expenses will be covered by company).
• Must hold an active, current and unrestricted RN license in Texas, with multi-state / compact privileges and have the ability to be licensed in all non-compact states.
• 3 + years clinical practice experience as an RN required
• 1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications
• Must be willing to travel to the local office as needed.

Preferred Qualifications

• Case Management in an integrated model
• Bilingual in Spanish and English
• Strong computer skills

Education

Associates Degree in Nursing

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.

This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work BehaviorsTM support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services.

We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

POSITION SUMMARY / RESPONSIBILITIES

Manages the care coordinators (case managers), home health coordinators and clerical staff to insure a smooth patient flow from preadmission to discharge and follow up in accordance with the patient’s and the payers requirements.

Works with the Manager for Social Services to ensure an interdisciplinary treatment plan of care for patients. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the manager of the team.

EDUCATION / EXPERIENCE

Graduation from an accredited college or university with a bachelor's degree in nursing is preferred. Required experience : minimum of two years recent management experience;

three years of hospital clinical nursing experience and one year experience in case management, utilization review or hospital quality assurance.

Experience in each of these areas in a hospital setting is preferred.

LICENSURE / CERTIFICATIONS

Current registration with the Texas State Board of Nurse Examiners and current CPR certification (BLS) is required. Case Manager Certification (CCM or ANCC) is highly desirable.

PI215782604

Description

The Hospital Case Manager (HCM) focuses on concurrent review of GMG MC patients (members) in the hospital and facility setting.

Utilizing nationally recognized care guidelines and the patient’s health plan coverage guidelines, the HCM monitors admissions and continued stays for Medical appropriateness.

The HCM develops a discharge (DC) plan in coordination with the physician(s), the patient and the family to promote a safe and timely discharge.

They act as an advocate for members and their families by linking them to educational resources and community resources to support their aftercare.

Effective utilization management of healthcare resources is a major function of this role.The HCM participates in the Patient Care Committee Meeting (PCC) and other GMG or Case Management (CM) team meetings to optimize care plans, treatment plans and GMG protocols.

DUTIES :

• Round daily on assigned GMG MC Patients in the hospital setting, and at least weekly on those in the SNF setting.
• Utilize nationally recognized care guidelines and the patient’s health plan coverage guidelines to monitor admissions and continued stays for Medical appropriateness.
• Assess the medical, physical, psycho-social and transition needs to anticipate the services, equipment, and follow up care that will be needed upon DC.
• Confer with physician(s), patient, and families in developing the transitional or DC plan.
• Demonstrate knowledge of utilization management, care coordination, and current standards of care as a foundation for transition planning activities.
• Enter timely and accurate information into the EMR to document pertinent patient / family communications, referral authorizations and plans.
• Collaborate effectively with other members of the GMG CM team to clearly communicate regarding coverage determinations, authorizations, and any special follow up needed post DC.
• Communicate regularly with the MC Medical Director on patient status, issues or questions.
• Serve as the clinical liaison with hospital, clinical and administrative staff. Provide information on the clinical authorizations for inpatient / SNF care and milestones achieved toward DC status.
• Attend weekly Patient Care Committee (PCC) as census allows.
• Provide constructive information to patients and families to minimize problems and increase customer satisfaction. Explain and reinforce the physician plan of care.
• Decision-making is usually based on prior practice or policy, with some interpretation. Must apply individual reasoning to the solution of problems.
• Maintain current knowledge of health plan benefits, health plan contracts and preferred provider network.
• With the assistance of other members of the GMG MC teams, guides physicians in their awareness of preferred contracts, providers and facilities.
• Perform Clinical High Risk Home Visits as assigned.
• Maintains strict confidentiality of all PHI; Protects laptop, cell phone, and documents.
• Performs all other related duties as assigned.

EDUCATION, EXPERIENCE & SKILLS :

• Education required : Bachelor’s or Associate’s degree in Nursing
• Current, unrestricted RN license required.
• Four or more years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions in adult and geriatric populations.
• Two or more years of managed care and / or case management experience preferred.
• Able to communicate clearly in both written and verbal format. Strong interpersonal skills.
• Strong organization, planning and decision making skills. Able to think independently to identify problems and define action plan to resolve.
• Proficient with Microsoft Office applications including Word, and Excel.
• Case Management Certification (CCM) preferred.

PREFERRED Language SKILLS :

Bilingual (English / Spanish) language proficiency.

Supervisory Responsibilities :

This job has no supervisory responsibilities.

Work Environment : Depending upon the area assigned, may be 100% clinical setting, office setting in a clinical environment : Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinic environment.

Physical Demands : Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs.

Close vision and ability to adjust focus.

Qualifications

Skills

Behaviors

Motivations

Education

Preferred

Bachelors or better in Nursing.

Experience

Licenses & Certifications

Required

Registered Nurse

The Case Manager is responsible for long term person-centered case management services from intake to annual reviews. The Case Manager will assist and guide families through complex healthcare systems and assist them in obtaining access to critical services.

Case Manager is assigned to every family in an effort to ensure they receive a unique care plan tailored to the needs of the child and family.

Minimum Qualifications

• Bachelor’s degree or higher in human service field, Education field or social work
• Two years of related experience working in community programs serving children with special health care needs.
• Highly proficient in Microsoft Office Suite
• Bilingual in English and Spanish
• Valid Texas Driver License with acceptable MVR and background check

Typical Duties

• Works alongside team to provide long term and person-centered case management services, including intake, assessment, development and implementation of services.
• Facilitates client interviews in a private setting (home, office, alternate sites) to ensure client privacy and confidentiality.
• Protects confidential information obtained through the course of conducting agency business.
• Effectively utilizes pre-survey to guide the development of the care plan for active cases and post-survey on all cases pending deactivation.
• Establishes care plans including referrals and direct assistance tailored to the needs of the child and family.
• Reviews family service plans on a quarterly / annual basis for all open cases updating progress notes and modifying as needed.
• Remains abreast of available resources on a local, state and national level and utilizes resources appropriately.
• Assists families in obtaining and completing applications for insurance and funding programs including but not limited to CSHCN, SSI, Medicaid waivers, etc.
• Manage client contacts, case files and ClientTrack (database) ensuring timely updates, thorough documentation and accurate information.
• Effectively manage average client caseload designated by program requirements.
• Actively participates in training, community networking and agency training courses relating to resources offered to families in need.
• Follows approval process for expenses incurred.
• Performs other duties, tasks and special projects as assigned.

The above description covers the principal duties and responsibilities of the job. The description shall not, however, be construed as a complete listing of all miscellaneous, incidental or similar duties which may be required from day-to-day.

The candidate selected for employment will be required to submit to a criminal background check, education verification and drug test.

Interested candidates should submit their resume, with salary requirements, via our career portal on our website at www.seekinghr.

com or contact us directly at (210) 679-4879 with any questions.

Equal Employment Opportunity Employer M / F / D / V

If you are passionate about transforming communities with a mission-driven organization, then we have the opportunity for you!

Since 1939, Lutheran Immigration and Refugee Service (LIRS) has offered welcome and hope to refugees. LIRS has transformed lives with the support and hard work of people like you, to welcome the most vulnerable to the United States from sea to shining sea.

We help people seeking safety from persecution in their home countries and reunite families torn apart by conflict. We resettle refugees.

We protect vulnerable children who arrive alone in the United States. We advocate for compassion and justice for all migrants.

Widely recognized for our expertise in implementing federal programs on behalf of refugees and migrants in the United States, conducts policy advocacy, and advances the protection and rights of vulnerable migrants.

Headquartered in the beautiful Inner Harbor of downtown Baltimore we provide services nationwide through a network of staff and affiliates.

Attracting and retaining the best talent is vital to our continued growth and we are proud to offer an excellent benefits package including medical, dental, vision available the first day of employment, professional development, tuition reimbursement, generous paid time off including 20 days of vacation, 12 days of sick leave, 12 paid holidays PLUS the week between Christmas and New Year's Day, 12 weeks of paid parental leave and up to 12 weeks of fully paid FMLA leave, company 403(b) contribution of 3%, an additional 7% match, Family Building benefits for reproductive procedures, adoption / foster care assistance, and an annual wellness benefit that can be customized to support your personal needs including funding enrichment classes, gym memberships, and healthy eating plans (to name a few) all in an inclusive and progressive environment! Lutheran Immigration and Refugee Service is a champion for all uprooted people.

Please join us as we make a difference in the lives of newcomers.

Reporting to the Director for Child and Family Services, the Clinical Case Manager will be responsible for providing casework and supportive services to children and families which includes ensuring the clients are connected to educational services, legal services, health services, job readiness programs, etc.

In addition to casework and supportive services, the Clinical Case Manager will also be responsible for communicating with stakeholders in an effective and timely manner to ensure case continuity.

This position is expected to function effectively with moderate supervision while following the guidelines given on procedures, along with agency, state, and federal regulatory requirements.

DUTIES

• Ensure that all assigned clients on your caseload and under your supervision receive referrals to include but not limited to medical, recreational, educational, and other supportive services in accordance with the time and documentation expectations of the program.
• Develop and completes assessments, service and treatment plans, progress notes, incident reports and any other necessary documentation in a timely manner.
• Create a trusting and safe relationship with the client and encourage personal growth of the client.
• Actively participate in weekly staff meetings with the clinical team and stakeholders.
• Attend, facilitate, and assist with providing on-going education and support services to adult caregivers.
• Attend weekly meetings with supervisor to consult on cases, to review case plan and direction and to evaluate client participation and progress.
• Maintain effective communication with community agencies or individuals involved in service provision.
• Attend and prepare for required court hearings (if applicable).
• Explore potential community resources and refer Case Managers and families for support, as needed.
• Ability to work flexible hours and work independently within the field.

QUALIFICATIONS

• Bachelor's degree in Social Services or related field of study from an accredited college required.
• Master's degree in Social Services or related field of study from an accredited college, preferred.
• At least two (2) years of experience in child welfare / case management, strongly preferred.
• Prior experience working with refugee and / or immigrant populations preferred.
• Bi-lingual English and Spanish required
• Knowledge of and adherence to federal, state, program, and agency regulations.
• Mature and stable judgment as well as sensitivity to various cultures and the unique history of refugees.
• Must maintain a broad knowledge of basic principles, concepts, and methodology of social work as acquired through a bachelor's level degree or professional experience.
• Excellent verbal and written communication skills.
• Ability to work under stress or in a fast-paced environment.
• Ability to work independently and exercise a high level of confidentiality.
• Computer and typing skills sufficient to perform essential job functions.
• Pass a criminal history screen, including state and local child protection agency registries.

Special Position Requirements

• Fluency in Spanish required
• Valid driver's license required
• Must be able to pass an FBI background check, as well as a CA / N check for every state in which they have resided in the last five years.

Lutheran Immigration and Refugee Service (LIRS) is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity, or expression, or any other characteristic protected by federal, state, or local laws.

We offer a competitive salary and comprehensive benefits package in an innovative and rewarding work environment. Benefits include medical, dental, and vision coverage effective on your first day of employment, 403(b) with company contribution and match, 20 days of vacation per year, tuition reimbursement, professional development and much more.

Salaries are based on the latest market data and reflect the education, skills and requirements for the role. Differentials may exist based on the region and language abilities.