CVS Health
Los Angeles, CA
Job Description Bilingual Spanish/English Required This is a telework role, but candidates must be licensed in the state of CA. Working schedule: Monday-Friday, 8am-5pm. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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. Fundamental Components • Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences • 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 conversation.
Pay Range The typical pay range for this role is: Minimum: 26.59 Maximum: 57.21
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – Bilingual Spanish/English Required – 3+ years of clinical practical experience as an RN – Registered Nurse with active CA state license in good standing
Preferred Qualifications – 2+ years of case management, discharge planning and/or home health care coordination experience – Experience working with adult and senior populations – CCM preferred – Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually – Excellent analytical and problem-solving skills – Effective communications, organizational, and interpersonal skills. – Ability to work independently – Effective computer skills including navigating multiple systems and keyboarding – Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, and Outlook
Education – Associates degree required – Bachelor’s degree preferred
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 Behaviors™ 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.
Job Description Bilingual Spanish/English Required This is a telework role, but candidates must be licensed in the state of CA. Working schedule: Monday-Friday, 8am-5pm. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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. Fundamental Components • Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences • 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 conversation.
Pay Range The typical pay range for this role is: Minimum: 26.59 Maximum: 57.21
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – Bilingual Spanish/English Required – 3+ years of clinical practical experience as an RN – Registered Nurse with active CA state license in good standing
Preferred Qualifications – 2+ years of case management, discharge planning and/or home health care coordination experience – Experience working with adult and senior populations – CCM preferred – Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually – Excellent analytical and problem-solving skills – Effective communications, organizational, and interpersonal skills. – Ability to work independently – Effective computer skills including navigating multiple systems and keyboarding – Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, and Outlook
Education – Associates degree required – Bachelor’s degree preferred
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 Behaviors™ 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.
CVS Health
Phoenix, AZ
Job Description Sign Up now for Aetna National Clinical Hiring Event! Aetna is growing and working to hire clinicians to support current and future clinical in all lines of our managed care business, including Commercial (Employer) contracts, Medicare, Medicaid and Utilization Management. We are hiring RNs, Social Workers (licensed Behavioral Health clinicians), and Case Management Coordinators with social services experience. This virtual event is on Nov 9th from 9-3pm EST. If interested in learning more or to RSVP, please clicking on this link: http://adtrk.tw/tp/rj6_cJEIU-I.K Qualifying candidates may be eligible for up to a $5000 sign on bonus. This role is work from home with 35% travel required in Maricopa County, Arizona to visit members. Working schedule: Monday-Friday, 8am-5pm Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona’s Medicaid agency, and deliver services throughout the state. Mercy Care is administered by Aetna, a CVS Health company. Our staff is employed by Aetna and CVS Health. This gives Mercy Care the resources of a national organization, and still allows us to bring our members the familiarity and presence of a local team of people who put our members at the center of everything we do. Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program. -Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members; Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. -Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals. -Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care; -Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. -Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. -Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -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. Monitoring, Evaluation, and Documentation of Care; -Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. #mercycareaz #mercycarejobs
Pay Range The typical pay range for this role is: Minimum: 19.50 Maximum: 38.99
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – 2+ years of case management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability. – Bilingual in Spanish (Oral and Written) – Willing and able to travel up to 35% in Maricopa County
Preferred Qualifications – Computer proficient with Microsoft Outlook/Word and Windows – Experience collaborating with medical professionals – Critical areas to succeed – organization, collaboration and time management
Education – Candidates must have earned a 4-year bachelor’s degree in social work, psychology, special education, or counseling, or be a licensed registered nurse.
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 Behaviors™ 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.
Job Description Sign Up now for Aetna National Clinical Hiring Event! Aetna is growing and working to hire clinicians to support current and future clinical in all lines of our managed care business, including Commercial (Employer) contracts, Medicare, Medicaid and Utilization Management. We are hiring RNs, Social Workers (licensed Behavioral Health clinicians), and Case Management Coordinators with social services experience. This virtual event is on Nov 9th from 9-3pm EST. If interested in learning more or to RSVP, please clicking on this link: http://adtrk.tw/tp/rj6_cJEIU-I.K Qualifying candidates may be eligible for up to a $5000 sign on bonus. This role is work from home with 35% travel required in Maricopa County, Arizona to visit members. Working schedule: Monday-Friday, 8am-5pm Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona’s Medicaid agency, and deliver services throughout the state. Mercy Care is administered by Aetna, a CVS Health company. Our staff is employed by Aetna and CVS Health. This gives Mercy Care the resources of a national organization, and still allows us to bring our members the familiarity and presence of a local team of people who put our members at the center of everything we do. Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program. -Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members; Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. -Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals. -Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care; -Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. -Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. -Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -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. Monitoring, Evaluation, and Documentation of Care; -Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. #mercycareaz #mercycarejobs
Pay Range The typical pay range for this role is: Minimum: 19.50 Maximum: 38.99
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – 2+ years of case management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability. – Bilingual in Spanish (Oral and Written) – Willing and able to travel up to 35% in Maricopa County
Preferred Qualifications – Computer proficient with Microsoft Outlook/Word and Windows – Experience collaborating with medical professionals – Critical areas to succeed – organization, collaboration and time management
Education – Candidates must have earned a 4-year bachelor’s degree in social work, psychology, special education, or counseling, or be a licensed registered nurse.
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 Behaviors™ 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.