Case Manager, Registered Nurse

CVS Health•Carapichaima, FL

6d•$60,522 - $129,615•Remote

About The Position

CVS Health is hiring a Case Manager, Registered Nurse, for its Community Care program, a member-centered, team-delivered, community-based care management model. The role coordinates comprehensive care by assessing member needs, creating personalized care plans, coordinating services among healthcare providers, advocating for members, and monitoring progress to support positive health outcomes and overall well-being. The position is for candidates who reside in Florida or Ohio and is performed from home subject to the stated work-from-home requirements. The case manager supports members with catastrophic cases and chronic or acute conditions across the continuum of care. Work may include telephonic and in-person contact, including visits to members’ homes, worksites, or physicians’ offices. The position collaborates with members and their families, providers, employers, insurers, attorneys, community organizations, and internal multidisciplinary teams. It assesses medical and vocational status, benefit eligibility, and care needs; coordinates appropriate resources and services; and monitors members’ progress toward desired outcomes. The role also provides education and prevention information, documents case activities, and follows applicable laws, regulations, carrier instructions, and company policies. This is a full-time, 40-hour-per-week position. The company provides equipment such as a computer, monitor, keyboard, and headset. The employee must provide workspace furniture and maintain an appropriate private home workspace and qualifying wired internet connection. The typical pay range is $60,522–$129,615, with eligibility for a CVS Health bonus, commission, or short-term incentive program. The position is eligible for benefits including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs, subject to eligibility.

Requirements

Must reside in Florida or Ohio.
Active and unrestricted Compact Registered Nurse (RN) licensure in the candidate’s state of residence (Florida or Ohio).
Associate’s Degree in Nursing required.
At least 2 years of case management, discharge planning, and/or home health care coordination experience.
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 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 and digital literacy skills.
Ability to deal tactfully with customers and the community.
Ability to handle sensitive information ethically and responsibly.
Ability to weigh the relative costs and benefits of potential actions to select an appropriate option.
Must meet work-from-home requirements: direct wired internet to the modem/router within 7 feet, minimum speeds of 25 Mbps download and 3 Mbps upload, and no Wi-Fi or satellite internet.
Must maintain a quiet, secure, private, organized home workspace compliant with CVS Health and HIPAA guidelines, allowing uninterrupted work during work hours.
Work-from-home colleagues must work within the state and city where they have confirmed they currently live.
Must obtain required internet speeds and comply with work-from-home requirements if hired.
Must be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
Must be able to communicate using digital channels such as email, calendar invitations, Teams messaging, and virtual meetings.
Must be able to access secure systems such as VPNs and EHR portals, secure devices and passwords, and recognize suspicious emails or links.
Must be able to resolve common technical issues independently or contact IT for unresolved issues.
Must be open to learning new skills as the workplace environment evolves.

Nice To Haves

3+ years of clinical practical experience, preferably with 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.
Bachelor’s Degree in Nursing.
Excellent analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Bilingual in Spanish.
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.

Responsibilities

Coordinate and facilitate comprehensive care by assessing member needs, developing personalized care plans, and coordinating services across healthcare providers.
Act as a liaison among members, clients, families, employers, providers, insurers, and healthcare personnel.
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 by telephone or in person, including possible meetings in homes, worksites, or physicians’ offices.
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 relevant stakeholders, including medical providers, attorneys, employers, and insurance carriers.
Prepare required documentation of casework activities.
Consult with internal multidisciplinary teams and, as appropriate, treating physicians or specialists about members’ care and treatment.
Provide education and prevention information to support medical outcomes.
Apply laws and regulations relevant to rehabilitation services and follow special instructions from insurance carriers and referral sources.
Evaluate members’ needs and benefit-plan eligibility, using clinical tools and information or data to facilitate integrated services.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Develop proactive courses of action to address issues, improve short- and long-term outcomes, and support overall wellness through integration.
Monitor member progress toward desired outcomes through assessment and evaluation.