Case Manager RN

Case Manager RN

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.

Position Summary

This Case Manager RN position is 100% remote, and the employee can live in any state. No travel is expected with this position.

Normal Working Hours: Monday- Friday, 8:00am - 4:30pm with a 10:30am-7:00pm rotation several times per Quarter in the time zone of residence. Rotational coverage of evenings, weekends and holidays will be per the needs of the department.

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills.

The responsibilities of this Case Manager RN position are to:

• Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.
• Conduct comprehensive clinical assessments.
• Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services.
• Advocate for patients to the full extent of existing health care coverage.
• Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency.
• Identify and escalate quality of care issues through established channels.
• Provide an expected very high level of customer service.
• Utilize assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Required Qualifications

• Active and unrestricted RN license in their state of residence and have the ability to obtain multi-state licensure upon hire
• 3+ years of acute care experience as an RN
• 3+ years of experience with Microsoft Suite of products
• 2+ years of Oncology Care experience

Preferred Qualifications

• Compact RN License
• Certified Case Manager (CCM)
• Case Management experience
• Managed Care experience
• Telephonic case management and/or telephonic customer service center experience

Education

• Minimum of Associate Degree in Nursing required
• BSN preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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.

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.