Case Manager, Registered Nurse (Remote)

CVS Health•Work At Home-Illinois, IL

7d•$66,575 - $142,576•Remote

About The Position

CVS Health is hiring a Registered Nurse Case Manager for its Community Care program, a member-centered, team-delivered, community-based care management model. The role coordinates comprehensive care by assessing members’ needs, developing personalized care plans, and coordinating services among healthcare providers. The Case Manager advocates for members, supports effective communication and resource use, and monitors progress to promote positive outcomes and well-being. The position serves members with catastrophic cases and chronic illnesses across the continuum of care. Work includes communicating with members and stakeholders, assessing medical or vocational status, coordinating care and community resources, and supporting condition management, wellness, and return to baseline, optimal function, or work. Interactions may be by phone or in person; home, worksite, or physician-office visits may be required. The position also prepares documentation, consults with multidisciplinary teams, provides education and prevention information, and follows applicable laws, regulations, company procedures, and referral-source instructions. This is a remote, work-from-home role. The employee must work from the state and city where they currently live, maintain a secure and private home workspace, and meet specified hardwired internet requirements. CVS Health provides work equipment; the employee supplies workspace furniture. The role is scheduled for 40 hours per week and is full time.

Requirements

Active and unrestricted RN licensure in Illinois; the license section specifies active and unrestricted Compact RN licensure in the state of residence (IL).
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 ability to use proprietary applications.
Ability to work in a fast-paced, high-volume environment and apply time management and prioritization skills.
Effective computer skills, including navigating multiple systems and keyboarding.
Working knowledge of problem-solving and decision-making skills, medical terminology, and digital literacy.
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.
Associate’s degree in nursing.
Ability to meet work-from-home requirements, including a hardwired internet connection within 7 feet of the modem/router with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private, tidy, and organized designated home workspace that complies with CVS Health and HIPAA guidelines and permits uninterrupted work.
Work from the state and city where the employee has confirmed they currently live.
Provide workspace furniture, such as a desk or standing desk, and commit to obtaining required internet speeds if hired.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 or similar collaboration applications.
Ability to access secure systems such as VPNs and EHR portals, follow basic security practices, and recognize suspicious emails or links.
Ability to troubleshoot common technical issues independently and contact IT when needed.
Openness to learning new skills as the workplace evolves.

Nice To Haves

Three or more years of clinical practical experience is preferred, particularly in 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 Spanish.
Residence in Illinois is preferred.

Responsibilities

Act as a liaison among members or clients, families, employers, providers, insurers, and healthcare personnel as appropriate.
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 and, when required, meet them at home, work, or a physician’s office.
Assess and analyze members’ medical or vocational status and develop care plans to support condition management, wellness, medical outcomes, return to work, or optimal functioning.
Communicate with members and relevant stakeholders, including medical providers, attorneys, employers, and insurance carriers.
Prepare required documentation of case work activities.
Consult with internal multidisciplinary teams and reach out to treating physicians or specialists regarding care and treatment when appropriate.
Provide education and prevention information to support medical outcomes.
Apply applicable laws and regulations for rehabilitation services and follow instructions from insurance carriers and referral sources.
Evaluate members’ needs and benefit-plan eligibility, using clinical tools and data to facilitate integrated care.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Develop proactive actions to address identified issues, improve short- and long-term outcomes, and support members’ overall wellness.
Monitor members’ progress toward desired outcomes through assessment and evaluation.