Case Manager Registered Nurse

CVS Health•Work At Home-Idaho, IN

1d•$54,095 - $116,760•Remote

About The Position

The Case Manager RN uses a collaborative process of assessment, planning, facilitation, and advocacy to connect members with options and services that meet their benefit plan and health needs. The goal is to promote optimal, cost-effective outcomes through communication and available resources. The role includes assessing health status and care coordination needs, conducting inpatient review and discharge planning, developing and implementing case management plans, monitoring and evaluating plans, involving the Medical Director as indicated, and closing cases when members meet discharge criteria. The position is 100% remote, with employees able to live in any state and no travel expected. Work is normally Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s time zone, with rotational evening, weekend, and holiday coverage as department needs require. The work includes time in a queue-type setting. The expected start date for this hiring cohort is December 14, 2026, and candidates must be available to start then. The role requires independent, sound judgment, strong decision-making, interpersonal, organizational, and time-management skills, the ability to manage competing priorities, and effective teamwork. The position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the stated base pay range. The pay range is $54,095 to $116,760. The position is full-time, with 40 anticipated weekly hours. Work-from-home requirements include a direct, hardwired internet connection to a modem/router within seven feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. Employees must have a quiet, secure, private, organized home workspace compliant with CVS Health and HIPAA guidelines and work from the state and city where they have confirmed residence. CVS Health provides equipment such as a keyboard, monitor, computer, and headset; employees provide their own workspace furniture. Employees must meet the internet requirements and follow all work-from-home requirements. The role involves using multiple monitors and applications, digital communication and collaboration tools, secure systems such as VPN and EHR portals, and common technical troubleshooting. The employee must follow security practices and be open to learning new skills as the workplace evolves. This full-time position is eligible for benefits including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Requirements

Active, unrestricted RN license in the state of residence and ability to obtain multi-state licensure upon hire.
At least 3 years of acute care experience as an RN.
At least 3 years of experience with Microsoft Suite products.
Strong problem-solving and clinical decision-making skills.
Ability to manage sensitive information professionally and confidentially.
Excellent communication and relationship-building skills.
Ability to work effectively with diverse patient populations and healthcare teams.
At least an associate degree in nursing.
Ability to meet work-from-home internet requirements: hardwired connection, minimum 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Ability to maintain a quiet, secure, private, organized home workspace compliant with CVS Health and HIPAA guidelines.
Ability to use multiple monitors and applications, digital communication tools, secure systems, and common troubleshooting procedures.
Must be able to start on December 14, 2026.

Nice To Haves

Compact RN License.
Certified Case Manager (CCM).
Case management experience.
Managed care experience.
Telephonic case management or telephonic customer service center experience.
Homecare experience.
Bachelor of Science in Nursing (BSN).

Responsibilities

Apply data-driven methods to identify members for individualized case management programs 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 and services.
Advocate for patients to the full extent of existing healthcare coverage.
Promote quality, cost-effective outcomes and suggest improvements to program or operational efficiency.
Identify and escalate quality-of-care issues through established channels.
Provide a very high level of customer service.
Assess members’ health literacy, technology capabilities, and readiness to change.
Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavioral changes.
Coach, inform, educate, and support members in making ongoing independent medical and healthy lifestyle choices.
Assess member health status and care coordination needs, conduct inpatient review and discharge planning, and develop, implement, monitor, and evaluate case management plans.
Involve the Medical Director when indicated and close cases when members meet discharge criteria.