Case Manager Registered Nurse

RN Case Manager

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This RN Case Manager position is 100% remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. Normal working hours: Monday through Friday between the hours of 8:30am – 5:00pm in their time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. Less than 5% travel may be required for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing.

The RN Case Manager 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 overall wellness.

RN Case Manager:

• Collaboratively 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.
• Through the use of clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member's needs and available benefits to collaborate and refer to programs offered by the plan sponsor.
• Applies clinical judgment to reduce risk factors, address complex health issues and social indicators.
• 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

Required Qualifications:

• Must have an active current and unrestricted RN license in state of residence. If located within the Nurse Licensure Compact jurisdiction, the ability to use their compact license without restriction
• Willingness and ability to obtain additional state licenses upon hire (paid for by the company)
• 3+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning)
• Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time
• A private designated workspace free of distractions and high-speed internet

Preferred Qualifications:

• Compact RN licensure
• 1+ years of case management experience
• Certified Case Manager (CCM) certification
• Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues.
• Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
• Strong telephonic communication skills
• 1+ years of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone.

Education:

• Associates Degree in Nursing required.
• Bachelor's in Science & Nursing preferred.

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $60,522.00 - $129,615.00

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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.