Case Manager, Registered Nurse (Remote)

CVS Health • Work At Home-Texas, TX

1d • $60,522 - $129,615 • Remote

About The Position

The Case Manager RN uses a collaborative process of assessment, planning, facilitation, and advocacy to identify options and services that meet members’ benefit-plan and health needs. The role coordinates care and resources to promote optimal, cost-effective outcomes. Work includes assessing health status and care-coordination needs, inpatient review, 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.

This is a 100% remote position open to employees living in any state, with no expected travel. The role includes time in a queue-type setting and requires independent judgment, sound decision-making, organization, time management, interpersonal skills, and teamwork. Normal hours are Monday through Friday between 8:00 a.m. and 5:00 p.m. in the employee’s time zone, with rotational evening, weekend, and holiday coverage as departmental needs require.

The employee must maintain a compliant home workspace and direct, hardwired internet connection meeting the stated speed requirements; Wi-Fi and satellite internet are not permitted. CVS Health provides equipment such as a keyboard, monitor, computer, and headset. The employee supplies workspace furniture and must work from the state and city where they have confirmed they live.

Requirements

• Active, 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 handle sensitive information professionally and confidentially.
• Excellent communication and relationship-building skills.
• Ability to work effectively with diverse patient populations and healthcare teams.
• Minimum Associate Degree in Nursing.
• Ability to obtain a direct, hardwired internet connection to a modem/router within 7 feet of the computer, 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 supports uninterrupted work.
• Must work within the state and city where the employee has confirmed they currently live.
• Provide personal workspace furniture, such as a desk or standing desk, and remain at a desk for extended periods.
• Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
• 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 when issues cannot be resolved.
• Openness to learning new skills as the workplace 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.
• Bachelor of Science in Nursing (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 needs and develop flexible approaches based on member needs, benefit plans, or external programs and services.
• Advocate for patients to the full extent of 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 engage members and promote lifestyle or behavior changes.
• Coach, inform, educate, and support members so they can make ongoing independent medical and healthy-lifestyle choices.
• Coordinate assessment, planning, facilitation, advocacy, inpatient review, and discharge planning as part of case management.
• Develop, implement, monitor, and evaluate case-management plans; involve the Medical Director when indicated and close cases when discharge criteria are met.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.

What This Job Offers

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