Case Manager, Registered Nurse (Remote)

CVS Health • New York, NY

1d • $66,575 - $142,576 • Remote

About The Position

The Case Manager RN role is 100% remote and can be performed from any state in which the employee resides. No travel is expected. Normal working hours are Monday through Friday between 8:00 a.m. and 5:00 p.m. in the employee’s time zone, with rotational coverage of evenings, weekends, and holidays based on departmental needs. The role includes working in a queue-type setting.

The Case Manager RN uses a collaborative process of assessment, planning, facilitation, and advocacy to connect members with options and services that meet their benefit plan and health needs. The work includes assessing health status and care coordination needs, conducting inpatient review and discharge planning, developing and implementing case management plans, monitoring and evaluating plans, involving the Medical Director when indicated, and closing cases when members meet discharge criteria. The position requires independent judgment, sound decision-making, effective organization and time management, interpersonal skills, and teamwork.

This is a full-time, work-from-home position. The employee must work from the state and city where they have confirmed they currently live, maintain a compliant and private home workspace, and meet the stated wired-internet requirements. The company provides work equipment such as a computer, monitor, keyboard, and headset; employees provide their own workspace furniture. The role offers a base pay range of $66,575 to $142,576 and may be eligible for a bonus, commission, or short-term incentive program. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

• Active and unrestricted RN license in the state of residence, with the ability to obtain multistate licensure upon hire.
• At least 3 years of acute care experience as an RN.
• At least 3 years of experience with Microsoft Suite products.
• Strong problem-solving and clinical decision-making skills.
• Ability to manage sensitive information professionally and confidentially.
• Excellent communication and relationship-building skills.
• Ability to work effectively with diverse patient populations and healthcare teams.
• Minimum of an Associate Degree in Nursing.
• Ability to meet work-from-home requirements, including a direct wired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.
• Ability to maintain a quiet, secure, private, organized home workspace compliant with CVS Health and HIPAA guidelines and suitable for uninterrupted work.
• Ability to work from the state and city where the employee has confirmed they currently live.
• Ability to work with multiple monitors and applications and communicate through digital channels, including email, calendar invites, Teams messaging, and virtual meetings.
• Ability to use Microsoft Office 365 or similar applications, access secure systems such as VPN and EHR portals, follow security practices, troubleshoot common technical issues, and contact IT when needed.
• Openness to learning new skills as the workplace environment evolves.

Nice To Haves

• Compact RN License.
• Certified Case Manager (CCM).
• Case Management experience.
• Managed Care experience.
• Telephonic case management and/or telephonic customer service center experience.
• BSN.

Responsibilities

• Use data-driven methods to identify members for individualized case management programs or referrals to alternative healthcare programs.
• Conduct comprehensive clinical assessments.
• Evaluate member needs and develop flexible approaches based on member needs, benefit plans, or external programs and services.
• Advocate for patients to the full extent of their existing healthcare coverage.
• Promote quality, cost-effective outcomes and suggest improvements to program or operational efficiency.
• Identify and escalate quality-of-care issues through established channels.
• Provide a very high level of customer service.
• Assess members’ health literacy, technology capabilities, and readiness to change.
• Use influencing and motivational interviewing skills to promote member engagement and lifestyle or behavior changes.
• Provide coaching, information, education, and support so members can make ongoing independent medical and healthy-lifestyle choices.
• Assess members’ health status and care coordination needs, perform inpatient review and discharge planning, and develop, implement, monitor, and evaluate case management plans.
• Involve the Medical Director when indicated and close cases when members meet discharge criteria.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources based on eligibility.
• May be eligible for a CVS Health bonus, commission, or short-term incentive program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree