Case Manager Registered Nurse

CVS Health • Work At Home-Pennsylvania, PA

3d • $60,522 - $129,615 • Remote

About The Position

The RN Case Manager is responsible for assessing members by phone and/or face to face, planning and implementing care, and coordinating case management activities. The role evaluates members’ medical needs to facilitate overall wellness. It is 100% remote, with candidates able to apply from any state, subject to working the stated hours and residing in the state and city where they have confirmed they live. The regular schedule is Monday through Friday, between 8:30 a.m. and 5:00 p.m. in the employee’s time zone, for a scheduled eight-hour shift. Weekend and holiday coverage may be required; currently, these duties are on-call and covered on a volunteer basis. Less than 5% travel may be required for meetings, training, system updates, or licensure requirements.

The Case Manager works with members to develop proactive plans that address identified issues, support short- and long-term outcomes, and promote overall wellness through integration. The role uses clinical tools and information such as assessments and claims to evaluate needs and available benefits, then collaborates and refers members to plan-sponsored programs. It applies clinical judgment to reduce risk factors and address complex health issues and social indicators, follows regulatory and company case management policies and procedures, and uses interviewing skills to engage members and understand their health status and needs.

The position requires an active, current, unrestricted RN license in the state of residence, three or more years of acute-care RN clinical experience, and an associate degree in nursing. Employees must be able to use multiple computer screens and programs, sit for extended periods, and maintain a private, distraction-free workspace with high-speed internet. The company provides equipment such as a keyboard, monitor, computer, and headset; employees provide their own workspace furniture. Home internet must be hardwired, meet the specified speed requirements, and not use Wi-Fi or satellite service. The role also requires navigating multiple applications and monitors, communicating through digital channels, using productivity and collaboration tools, accessing secure systems, following security practices, troubleshooting routine technical issues, and adapting to new skills and workplace changes.

Requirements

• Active, current, unrestricted RN license in the state of residence; applicants in a Nurse Licensure Compact jurisdiction must be able to use their compact license without restriction.
• Willingness and ability to obtain additional state licenses after hire; the company pays for these licenses.
• Three or more years of acute-care clinical experience as an RN, including general medical, post-surgical, specialty, pediatrics, ICU, case management, or discharge planning experience.
• Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods.
• A private, designated workspace free of distractions and high-speed internet.
• Associate degree in nursing.
• Ability to obtain and use a direct, hardwired internet connection to a modem/router within seven feet of the computer, with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Ability to work from the state and city where the employee has confirmed they currently live, and to maintain a quiet, secure, private, organized home workspace compliant with company and HIPAA guidelines.
• 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 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 for unresolved issues.
• Openness to learning new skills as the workplace evolves.

Nice To Haves

• Compact RN licensure.
• One or more years of case management experience.
• Certified Case Manager (CCM) certification.
• Strong customer service skills, including attentiveness, sensitivity to certain issues, and proactive identification and resolution of issues.
• Experience with Microsoft Office, including PowerPoint, Excel, and Word.
• Strong telephonic communication skills.
• One or more years of experience using computers and navigating multiple monitors while speaking with someone on the telephone.
• Bachelor of Science in Nursing.

Responsibilities

• Assess members by telephone and/or face to face; plan, implement, and coordinate case management activities to evaluate medical needs and facilitate wellness.
• Collaboratively develop proactive courses of action to address member issues, improve short- and long-term outcomes, and support overall wellness through integration.
• Use clinical tools and review information such as assessments and claims to evaluate member needs and available benefits; collaborate and refer members to plan-sponsored programs.
• Apply clinical judgment to reduce risk factors and address complex health issues and social indicators.
• Use case management processes in compliance with regulatory requirements and company policies and procedures.
• Use interviewing skills to engage members and determine their health status and needs through questions and conversation.
• Work the scheduled hours and comply with work-from-home, location, internet, workspace, systems-access, and security requirements.
• May provide on-call weekend or holiday coverage as needed; currently these duties are covered on a volunteer basis.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, subject to 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