Case Manager, Registered Nurse (Remote)

CVS Health•New York, NY

7d•$66,575 - $142,576•Remote

About The Position

CVS Health is seeking a Registered Nurse Case Manager for its Community Care program, a member-centered, team-delivered, community-based care management model. The role coordinates and facilitates 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 use, and monitors progress to promote positive outcomes and overall well-being. The role serves injured, acutely ill, chronically ill, and catastrophic-case members across the continuum of care. Work includes coordinating with members and their families, providers, employers, insurers, and community organizations; facilitating referrals and appropriate levels of care; assessing clinical and, where applicable, vocational status; and developing care plans to support condition management, wellness, functional outcomes, and timely return to work where appropriate. The Case Manager documents case activities, consults with multidisciplinary teams, provides education and prevention information, and follows applicable laws, regulations, carrier instructions, and company policies. This is a remote work-from-home position. The employee must work from the state and city where they have confirmed they currently live, maintain a private and secure home workspace, and meet the stated wired internet requirements. CVS Health provides work equipment; the employee provides workspace furniture. The role is listed as full time, with 40 anticipated weekly hours.

Requirements

Active and unrestricted RN licensure in New York is listed as required; the License section also specifies active and unrestricted Compact RN licensure in the state of residence (FL or OH).
At least 2 years of case management, discharge planning, and/or home health care coordination experience.
Associate’s Degree in Nursing.
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.
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 community members.
Ability to handle sensitive information ethically and responsibly.
Ability to consider the relative costs and benefits of potential actions to select an 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; Wi-Fi and satellite internet are not permitted.
Ability to maintain a quiet, secure, private, tidy, and organized designated home workspace that complies with CVS Health and HIPAA guidelines and allows uninterrupted work.
Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 or similar applications.
Ability to access secure systems such as VPNs and EHR portals, secure devices and passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently and contact IT for issues that cannot be resolved.
Openness to learning new skills as the workplace evolves.

Nice To Haves

Candidate preferably resides in New York.
Three or more years of clinical practical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac care, or home health with Medicare members.
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 and their 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 telephonically or in person, including at homes, worksites, or physician offices when required.
Assess and analyze members’ medical and/or vocational status and develop plans of care to support condition management, wellness, medical outcomes, timely return to work, or optimal functioning.
Communicate with members and stakeholders such as medical providers, attorneys, employers, and insurance carriers.
Prepare required documentation of case work activities.
Consult with internal multidisciplinary teams to help members achieve the best health outcomes.
Contact treating physicians or specialists about courses of care and treatment as appropriate.
Provide education and prevention information to support 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 functions using clinical tools and data.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Develop proactive courses of action to address issues and improve short- and long-term outcomes and overall wellness.
Monitor member progress toward desired outcomes through assessment and evaluation.