Case Manager Registered Nurse

CVS Health•Work At Home-Pennsylvania, PA

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 an individual’s benefit plan and health needs. The role coordinates communication and available resources to promote optimal, cost-effective outcomes. Work includes assessing members’ health status and care coordination needs, inpatient review, discharge planning, developing and implementing case management plans, monitoring and evaluating plans, involving the Medical Director as indicated, and closing cases when discharge criteria are met. The position requires independent, sound judgment; strong decision-making, interpersonal, organizational, and time-management skills; the ability to manage multiple priorities; and effective teamwork. The work includes time in a queue-type setting. The role is 100% remote, with no travel expected. Normal hours are Monday through Friday between 8:00 a.m. and 5:00 p.m. in the employee’s time zone of residence, with rotational evening, weekend, and holiday coverage as department needs require. The employee must work from a quiet, secure, private, and organized designated home workspace that complies with CVS Health and HIPAA guidelines and supports uninterrupted work. A direct, hardwired internet connection to a modem or router within seven feet of the computer is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. Employees must work within the state and city where they have confirmed they currently live. CVS Health provides equipment such as a keyboard, monitor, computer, and headset; the employee supplies workspace furniture. The role also requires navigating multiple monitors and applications, using digital communication and collaboration tools, accessing secure systems, following security practices, and troubleshooting common technical issues.

Requirements

Active and 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 manage sensitive information professionally and confidentially.
Excellent communication and relationship-building skills.
Ability to work effectively with diverse patient populations and healthcare teams.
At least an Associate Degree in Nursing.
Ability to obtain or have a direct, hardwired internet connection meeting the specified location and speed requirements; Wi-Fi and satellite internet are not permitted.
Ability to work in a quiet, secure, private, designated home workspace compliant with CVS Health and HIPAA guidelines.
Ability to work within the state and city where the employee has confirmed they currently live.
Ability to use multiple monitors and applications, digital communication tools, collaboration and scheduling tools, secure systems, and basic technical troubleshooting procedures.
Commitment to obtaining required internet speeds and adhering to Work From Home requirements if hired.
Ability to work Monday through Friday during the stated daytime hours in the employee’s time zone, with rotational evening, weekend, and holiday coverage as needed.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Compact RN License.
Certified Case Manager (CCM).
Case Management experience.
Managed Care experience.
Telephonic case management or telephonic customer service center experience.
Experience with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, and PowerPoint) or similar tools such as Google Workspace.

Responsibilities

Apply data-driven methods to identify members and create individualized case management programs or referrals to alternative healthcare 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.
Use assessment techniques to determine members’ health literacy, technology capabilities, and readiness to change.
Use influencing and motivational interviewing skills to promote member engagement and lifestyle or behavior changes.
Coach, inform, educate, and support members to empower them to make ongoing independent medical and healthy lifestyle choices.
Assess members’ 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 as indicated and close cases when members meet discharge criteria.