Work in Arizona Jobs

Job Information

CVS Health Transplant Case Manager RN Registered Nurse in Phoenix, Arizona

Job Description

Transplant Nurse Case Manager (Txp CM) conducts review and determination of medical necessity of prior authorization requests related to the transplant services. Txp CM is responsible for care coordination between the member, transplant center, PCP, specialists, pharmacy, & etc. Txp CM gathers documentation and presents written case summary to the health plan's MD for the recommendations. Other responsibilities include telephonically 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. 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 outcome.

Must reside in state of Arizona. Quarterly meetings in the office.

Schedule is Monday-Friday standard business hours. No nights, and no weekends. Few holidays!

Fundamental Components

Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility. 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 take into account 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. 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.

Background Experience

Utilization Management or Case Management in an integrated healthcare model/managed care setting required

Minimum of 5 years clinical practice experience

Transplant experience is preferred

Knowledge of Medicaid and Medicare preferred

LICENSE

RN with current unrestricted state of Arizona licensure required.

Additional Job Information

Typical office working environment with productivity and quality expectations Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written.

Education

Bachelor's degree or equivalent experience

Percent of Travel Required

0 - 10%

Business Overview

Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

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