Case Manager Registered Nurse - Work at Home New York

CVS Health•York, PA

6d•$66,575 - $142,576•Remote

About The Position

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 The Case Manager RN is responsible for providing comprehensive care management services to members with complex medical, behavioral health, and social needs. The role includes conducting clinical assessments, developing and monitoring person-centered care plans, coordinating care across providers and community resources, facilitating transitions of care, identifying and addressing barriers to health outcomes, and ensuring members receive medically necessary and cost-effective services. The Case Manager RN collaborates with interdisciplinary teams, members, caregivers, and providers to promote quality outcomes, member satisfaction, regulatory compliance, and achievement of organizational goals.

Requirements

Active and unrestricted Registered Nurse (RN) license in the applicable state.
Minimum of 3 to 5 years of clinical nursing experience, preferably in care management, case management, home care, long-term care, managed care, utilization management, or community-based healthcare settings.
Experience coordinating care for members with complex medical, behavioral health, and psychosocial needs.
Strong knowledge of chronic disease management, care coordination, and healthcare delivery systems.
Ability to perform clinical assessments, identify member needs, and develop comprehensive care plans.
Excellent communication, organizational, critical thinking, and problem-solving skills.
Proficiency in Microsoft Office applications and electronic documentation systems.
Ability to work independently while effectively collaborating with interdisciplinary teams.
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer.
A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi 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.
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).
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
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.
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.

Nice To Haves

Certified Case Manager (CCM) certification or willingness to obtain certification.
Experience working in Managed Long-Term Care (MLTC), Medicare, Medicaid, Dual Eligible, or other managed care populations.
Knowledge and experience with the Uniform Assessment System (UAS-NY) and person-centered service planning.
Experience coordinating home and community-based services (HCBS), long-term services and supports (LTSS), and behavioral health services.
Bilingual skills preferred.
Experience working in a remote or field-based care management environment
Bachelor’s Degree in Nursing (BSN) preferred.
Additional certifications in Case Management, Care Coordination, Utilization Management, or related specialties are preferred.
Openness to learning new skills in the future as the workplace environment evolves

Responsibilities

Conducting clinical assessments
Developing and monitoring person-centered care plans
Coordinating care across providers and community resources
Facilitating transitions of care
Identifying and addressing barriers to health outcomes
Ensuring members receive medically necessary and cost-effective services
Collaborating with interdisciplinary teams, members, caregivers, and providers to promote quality outcomes, member satisfaction, regulatory compliance, and achievement of organizational goals.