Case Manager, Registered Nurse (Remote)

CVS Health•Work At Home-Ohio, OH

1d•$60,522 - $129,615•Remote

About The Position

The Case Manager RN position is 100% remote, may be performed from any state, and does not require travel. The role uses a collaborative process of assessment, planning, facilitation, and advocacy to identify options and services that meet members’ benefit plan and health needs and promote optimal, cost-effective outcomes. This includes assessing health status and care coordination needs, conducting inpatient review and 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. The position requires independent, sound judgment; strong decision-making, interpersonal, organizational, and time-management skills; teamwork; and the ability to manage multiple priorities. The role includes working in a queue-type setting and providing a high level of customer service. Normal working 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 department needs require. The employee must meet work-from-home requirements, including a direct, hardwired internet connection to a modem/router within seven feet of the computer with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. The home work location must be quiet, secure, private, free from distractions, organized, compliant with CVS Health and HIPAA guidelines, and allow uninterrupted work. Employees must work within the state and city where they have confirmed they live. The company provides equipment such as a keyboard, monitor, computer, and headset; employees provide their own workspace furniture. The role involves extended periods at a desk. The employee must be comfortable using multiple monitors and applications, digital communication and collaboration tools, secure systems such as VPN and EHR portals, and common troubleshooting processes, and must be open to learning new skills as the workplace evolves.

Requirements

Active, unrestricted RN license in the state of residence and 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 health care teams.
Minimum Associate Degree in Nursing.
Ability to meet the stated work-from-home internet, workspace, location, and security requirements.
Comfort using multiple monitors and applications, digital communication and collaboration tools, and secure systems; ability to troubleshoot common technical issues and contact IT when needed.

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).
Experience with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or similar tools such as Google Workspace.

Responsibilities

Use data-driven methods to identify members for individualized case management programs or referrals to alternative health care programs.
Conduct comprehensive clinical assessments.
Evaluate member 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 health care 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 support member engagement and lifestyle or behavior changes.
Provide coaching, information, education, and support to empower members to make ongoing independent medical and healthy lifestyle choices.
Assess health status and care coordination needs, conduct inpatient review and discharge planning, and develop, implement, monitor, and evaluate case management plans.
Involve the Medical Director when indicated and close cases when members meet discharge criteria.