Case Manager, Registered Nurse (Remote)

CVS Health•Work At Home-Michigan, MI

7d•$60,522 - $129,615•Remote

About The Position

CVS Health is hiring a Registered Nurse Case Manager for its Community Care program, a member-centric, team-delivered, community-based care management model. The role coordinates comprehensive care by assessing member needs, developing personalized care plans, and coordinating services across healthcare providers. The case manager advocates for members, supports effective communication and resource utilization, and monitors progress to promote positive outcomes and overall well-being. Members may be served by phone or in person, including at their homes, worksites, or physicians’ offices. The position coordinates care management for catastrophic cases and chronically ill members across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care. It assesses medical and vocational status, evaluates needs and benefit eligibility, develops and monitors care plans, collaborates with multidisciplinary teams and other stakeholders, documents case activities, and provides education and prevention information. The role applies relevant laws, regulations, carrier instructions, and company policies to support wellness, medical outcomes, functional recovery, and timely return to work where appropriate. This is a remote, full-time position with 40 anticipated weekly hours. The successful candidate must work from their confirmed residence within the applicable state and city and maintain a quiet, secure, private, HIPAA-compliant home workspace. A direct-wired internet connection is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. The company provides equipment such as a computer, monitor, keyboard, and headset, while the employee provides workspace furniture. The role involves use of multiple monitors and applications, secure systems such as VPN and EHR portals, and digital communication and collaboration tools.

Requirements

Active and unrestricted RN licensure in Michigan; the license section specifies an active and unrestricted Compact RN license in the state of residence (MI).
At least 2 years of case management, discharge planning, and/or home health care coordination experience.
Associate’s degree in Nursing is required.
Proficiency with standard corporate software, including Microsoft Word, Excel, Outlook, and PowerPoint, and some proprietary applications.
Ability to work in a fast-paced, high-volume environment and use time-management and prioritization skills.
Effective computer skills, including navigating multiple systems and keyboarding.
Working knowledge of problem-solving and decision-making skills.
Working knowledge of medical terminology and digital literacy.
Ability to deal tactfully with customers and the community.
Ability to handle sensitive information ethically and responsibly.
Ability to weigh the relative costs and benefits of potential actions to choose the most appropriate option.
Ability to meet work-from-home requirements, including a direct-wired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload, and a quiet, secure, private, HIPAA-compliant workspace.
Ability to work within the state and city where the employee has confirmed they currently live.
Ability to use multiple monitors and applications, digital communication tools, secure systems, and troubleshoot common technical issues.

Nice To Haves

Candidate preferably resides in Michigan.
Three or more years of clinical practical experience is preferred, particularly in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac care, or home health with Medicare members.
Bachelor’s degree in Nursing.
National professional certification such as CRC, CDMS, CRRN, COHN, or CCM.
Excellent analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Bilingual Spanish.

Responsibilities

Act as a liaison among members or clients, families, employers, providers, insurers, and healthcare personnel as appropriate.
Implement and coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care.
Interact with members by telephone or in person and, when required, meet them at home, work, or a physician’s office.
Assess and analyze medical and/or vocational status and develop care plans to support condition management, wellness, medical outcomes, functional recovery, and return to work where appropriate.
Communicate with members and other stakeholders, including medical providers, attorneys, employers, and insurance carriers, by telephone or in person as appropriate.
Prepare required documentation of casework activities.
Consult with internal multidisciplinary teams to help members achieve the best health outcomes.
Contact treating physicians or specialists about care and treatment as appropriate.
Provide education and prevention information to support optimal medical outcomes.
Apply laws and regulations governing rehabilitation services and special instructions from insurance carriers and referral sources.
Evaluate member needs and benefit plan eligibility, and facilitate integrated services using clinical tools and information or data.
Use case management processes in accordance with regulatory requirements and company policies and procedures.
Develop proactive courses of action to address issues, improve short- and long-term outcomes, and support members’ overall wellness through integration.
Monitor member progress toward desired outcomes through assessment and evaluation.