Care Manager - Registered Nurse - Work From Home (CST)

Job Summary The Care Manager—Registered Nurse is a key member of the Special Needs Plan (SNP) care team, responsible for coordinating care for members with multiple chronic medical and behavioral health conditions and social determinants of health needs. The role includes comprehensive assessments, developing and implementing individualized care plans, educating members and families, documenting interventions, and collaborating with an interdisciplinary team to ensure optimal outcomes. Key Responsibilities Spend 50-75% of the day engaging members by phone and coordinating their care. Compile clinical information and partner with members to develop individualized care plans that set goals and interventions. Provide evidence‑based disease‑management education and support to help members achieve health goals. Ensure appropriate members of the interdisciplinary care team are involved in member care. Support a seamless health‑care experience through coordinated care. Maintain meticulous documentation of care‑management activities in the electronic health record. Collaborate with team participants to address barriers to care and develop strategies for maintaining stable health. Identify and connect members with health‑plan benefits and community resources. Meet regulatory requirements within specified timelines. Support other Care Team members through clinical decision making and guidance as needed. Perform additional responsibilities assigned by leadership to support team objectives, operational efficiency, and high‑quality care, including participation in special projects, process‑improvement initiatives, or mentoring new team members. Essential Competencies and Functions Meet performance and productivity metrics, including call volume, member engagement, and regulatory requirements. Conduct oneself with integrity, professionalism, and self‑direction. Be willing to learn the role of care management within Medicare and Medicaid managed care. Have familiarity with community resources and services. Navigate and utilize healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative relationships with members and colleagues. Communicate effectively, both verbally and in writing. Demonstrate excellent customer service and engagement skills. Required Qualifications Active and unrestricted Registered Nurse (RN) licensure in the state of Missouri or a compact licensure in the state of residence. Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams. Access to a private, dedicated space for work and the ability to work independently at home. Minimum 3 years of nursing experience and 2 years of case management, discharge planning, and/or home‑healthcare coordination experience. Associate of Science in Nursing (ASN) degree (required) and Bachelor of Science in Nursing (BSN) preferred. Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members. Experience working with individuals with social‑determinants of health needs, chronic medical conditions, and/or behavioral health. Experience conducting health‑related assessments and facilitating the care‑planning process. Bilingual skills, especially English–Spanish. Compensation Pay range: $54,095.00 – $116,760.00 annually. Eligible for CVS Health bonus, commission, or short‑term incentive programs in addition to the base pay. Benefits Eligible for a comprehensive benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and additional resources, based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr