Case Manager Registered Nurse

CVS Health • Washington, NV

12d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Nurse Case Manager The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. The Nurse Case Manager utilizes clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes. Key responsibilities include conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health. The Nurse Case Manager reviews prior claims, evaluates work capacity, and determines the need for referrals to clinical resources. Collaboration with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.

Requirements

• An active and unrestricted RN license in the state of residence
• Willing and able to obtain additional state licenses upon hire (Paid for by the company)
• 3+ years' experience of acute care and/or case management
• 2+ years' Med/Surg experience
• Must be willing to work Mon-Fri 8-430 PST time zone
• Associate's Degree in Nursing
• Registered Nurse in your state of residence

Nice To Haves

• Prefer candidate in PST Zone
• Behavioral Health experience
• Certified Case Manager
• Managed care experience
• Strong telephonic communication skills
• Ability to manage multiple priorities, effective organizational, and time management skills
• Ability use a computer station and sit for extended periods of time

Responsibilities

• delivering comprehensive case management services through telephonic and/or face-to-face interactions
• assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness
• utilizes clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes
• conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health
• reviews prior claims, evaluates work capacity, and determines the need for referrals to clinical resources
• Collaboration with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning
• This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines
• understanding member needs and facilitating smooth transitions to appropriate programs and services

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

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