Case Manager, Registered Nurse (Remote)
About The Position
The Nurse Case Manager delivers comprehensive case management services through telephonic and/or face-to-face interactions. The role assesses, plans, implements, and coordinates care strategies to support members’ medical needs and promote overall wellness. It operates within regulatory and organizational policies, using case management processes and service strategies aligned with network management and clinical coverage guidelines. Strong interviewing and engagement skills are important for understanding member needs and facilitating transitions to appropriate programs and services.
Requirements
- Active and unrestricted RN license in the state of residence.
- Willingness and ability to obtain additional state licenses upon hire; the company pays for these licenses.
- At least 3 years of acute care and/or case management experience.
- At least 2 years of Med/Surg experience.
- Willingness to work Monday through Friday, 8:00 a.m.–4:30 p.m. local time.
- Associate’s degree in Nursing.
- RN license in the state of residence.
Nice To Haves
- Candidate located in the Pacific Time Zone.
- Behavioral Health experience.
- Certified Case Manager.
- Managed care experience.
- Strong telephonic communication skills.
- Ability to manage multiple priorities, with effective organizational and time management skills.
- Ability to use a computer station and sit for extended periods.
Responsibilities
- Use clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans addressing short- and long-term health outcomes.
- Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
- Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
- Collaborate with supervisors and multidisciplinary teams to overcome barriers and optimize care planning.
Benefits
- Medical, dental, and vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs and other resources, based on eligibility.
- Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
