Case Manager Registered Nurse (Remote, EST)

CVS Health • Work At Home-Ohio, SC

2d • $60,522 - $129,615 • Remote

About The Position

The Community Care Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals’ and families’ comprehensive health needs through communication and available resources, promoting quality and cost-effective outcomes. The role serves as a liaison among members or clients and their families, employers, providers, insurers, and other healthcare personnel.

The Case Manager coordinates case management activities for catastrophic cases and chronically ill members or clients across the continuum of care. This may include referrals to consultants, home care visits, use of community resources, and alternative levels of care. Interactions take place by telephone or in person, including potentially in members’ homes, worksites, or physicians’ offices.

The position assesses medical and/or vocational status and develops care plans to support condition management, wellness, medical outcomes, return to work or optimal functioning, and benefit eligibility determinations where applicable. The Case Manager documents case work, consults with multidisciplinary teams, may contact treating physicians or specialists, provides education and prevention information, and applies relevant laws, regulations, carrier instructions, and company policies. The role evaluates needs and benefit eligibility, monitors progress toward outcomes, and develops proactive actions to improve short- and long-term outcomes.

This is a remote, full-time role for a candidate residing in the specified South Region states. The work schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. The home work location must meet the stated security, privacy, and internet requirements. The company provides computer equipment, while the colleague supplies workspace furniture.

Requirements

• Reside in the South Region: OH, VA, NC, KY, TN, SC, GA, AL, MS, AR, LA, or FL.
• Be willing to work Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time.
• Hold an active and unrestricted Compact Registered Nurse (RN) license in Ohio or the state of residence.
• Have at least 3 years of clinical practical experience; experience with diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care with Medicare members is preferred.
• Have at least 2 years of case management, discharge planning, and/or home health care coordination experience.
• Have an associate’s degree or nursing diploma.
• Meet work-from-home requirements, including a direct wired internet connection with at least 25 Mbps download and 3 Mbps upload, and a quiet, secure, private designated work location compliant with company and HIPAA guidelines.
• Work from within the state and city where the colleague has confirmed they currently live.
• Provide workspace furniture, such as a desk or standing desk, and commit to meeting work-from-home requirements.
• Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Be able to communicate through digital channels, including email, calendar invites, Teams messaging, and virtual meetings.
• Have experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
• Be able to access secure systems, follow computer and password security practices, and recognize suspicious emails or links.
• Be able to troubleshoot common technical issues independently and contact IT for unresolved issues.
• Be open to learning new skills as the workplace evolves.

Nice To Haves

• Bilingual in Spanish.
• Excellent analytical and problem-solving skills.
• Effective communication, organizational, and interpersonal skills.
• Ability to work independently.
• Willingness and ability to obtain additional state RN licenses if needed; the company will provide support.
• National professional certification such as CRC, CDMS, CRRN, COHN, or CCM.
• Bachelor’s degree.

Responsibilities

• Assess, plan, facilitate, coordinate, evaluate, and advocate for services that address members’ and families’ comprehensive health needs.
• Act as a liaison among members or clients, families, employers, providers, insurers, and healthcare personnel.
• 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 or clients by telephone or in person, potentially in homes, worksites, or physician offices.
• Assess medical and/or vocational status and develop care plans to support condition management, wellness, medical outcomes, return to work, optimal functioning, and benefit eligibility determinations.
• 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 to help members achieve the best health outcomes.
• Contact treating physicians or specialists about the course of care and treatment when appropriate.
• Provide education and prevention information to promote favorable medical outcomes.
• Apply applicable laws, regulations, insurance-carrier instructions, and referral-source requirements.
• Testify when required to substantiate relevant case work or reports.
• Evaluate members’ needs and benefit plan eligibility and facilitate integrative functions using clinical tools and data.
• Use case management processes in compliance with regulatory requirements and company policies and procedures.
• Develop proactive actions to address issues, improve short- and long-term outcomes, and support members’ overall wellness.
• Monitor members’ progress toward desired outcomes through assessment and evaluation.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting physical, emotional, and financial well-being, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree