CVS Health Case Manager in Denver, Colorado
This position will be working from home, and will require work out of the nearest office location approximately 2-3 days per week once COVID restrictions are lifted.
Responsible for telephonically assessing, planning, implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient’s appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
Works telephonically with workers’ compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services. Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer. Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes. Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee’s best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services. Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations. Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work. Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Adheres to all appropriate privacy, security and confidentiality policies and procedures. Performs other duties as assigned.
Strong analytical skills used to identify and resolve problems.
Previous workers compensation, case management, utilization review or managed care experience preferred.
Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred, but not required.
Minimum of 3 years clinical practice experience required.
Registered Nurse (RN) with active state license in good standing in the state where job duties are performed.
Effective communications, organizational, and interpersonal skills.
Bachelor's degree in a closely-related field, or equivalent combination of education and experience.
Associate's degree or equivalent experience
Percent of Travel Required
0 - 10%
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.