Case Manager, Registered Nurse (Remote)

CVS Health•Carapichaima, CT

4d•$54,095 - $142,576•Remote

About The Position

CVS Health is hiring a remote Registered Nurse Case Manager for its Community Care program, a member-centered, team-delivered, community-based care management model. The role coordinates comprehensive care by assessing member needs, developing personalized care plans, coordinating services across healthcare providers, advocating for patients, and monitoring progress to promote positive outcomes and overall well-being. The Case Manager collaborates with members, providers, and community organizations to address healthcare and social determinant needs.

Requirements

Active and unrestricted Compact Registered Nurse (RN) license in the state of residence: PA, OH, FL, NJ, GA, NC, TX, or CT.
At least 2 years of case management, discharge planning, and/or home health care coordination experience.
Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint, and some proprietary applications.
Ability to work in a fast-paced, high-volume environment using time management and prioritization skills.
Efficient computer skills, including navigating multiple systems and keyboarding.
Working knowledge of problem-solving and decision-making skills.
Working knowledge of medical terminology.
Working knowledge of digital literacy skills.
Ability to deal tactfully with customers and the community.
Ability to handle sensitive information ethically and responsibly.
Ability to consider the relative costs and benefits of potential actions to select the most appropriate option.
Associate’s Degree in Nursing.
Ability to meet work-from-home requirements, including a direct wired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Ability to maintain a quiet, secure, private, organized home work location that complies with CVS Health and HIPAA guidelines and allows uninterrupted work.
Work from within the state and city where the employee has confirmed they currently live.
Commitment to obtain the required internet speeds and adhere to work-from-home requirements if hired.
Ability to use multiple monitors and applications simultaneously and communicate through digital channels such as email, calendar invitations, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 or similar applications and to access secure systems such as VPNs and EHR portals while following computer and password security practices.
Ability to independently resolve common technical issues and contact IT for issues that cannot be resolved.
Openness to learning new skills as the workplace environment evolves.
At least 3 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.

Nice To Haves

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.
Bachelor’s Degree in Nursing.

Responsibilities

Act as a liaison among members, clients, families, employers, providers, insurance companies, 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 and clients by telephone or in person, including meeting in homes, worksites, or physician offices when required.
Assess and analyze members’ or clients’ medical and/or vocational status and develop plans of care to support condition management, wellness, medical outcomes, return to work, or optimal functioning, and determine benefit eligibility as appropriate.
Communicate with members and other stakeholders, including medical providers, attorneys, employers, and insurance carriers, by telephone or in person.
Prepare required documentation of case work activities.
Consult with internal multidisciplinary teams to help members maximize health outcomes.
Reach out to treating physicians or specialists about the course of care and treatment as appropriate.
Provide education and prevention information to support positive medical outcomes.
Apply laws and regulations governing rehabilitation services and special instructions required by insurance carriers and referral sources.
Evaluate members’ needs and benefit-plan eligibility, and facilitate integrated functions using clinical tools and information or data.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Facilitate condition management, wellness, medical outcomes, return to baseline, optimal function, or return to work.
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.