Case Manager Registered Nurse

CVS Health • New York, NV

3d • $60,522 - $129,615 • Remote

About The Position

The RN Case Manager assesses, plans, implements, and coordinates case management activities with members by telephone and/or face to face to evaluate medical needs and support overall wellness. The role uses clinical tools, information and data review, claims history, and member interviews to assess health needs, benefit-plan eligibility, work capacity, and restrictions or limitations. Assessments consider all conditions, including comorbidities and multiple diagnoses affecting functionality.

The RN develops proactive courses of action to improve short- and long-term outcomes, support wellness through integration, reduce risk factors and barriers, and address complex health and social indicators. The role facilitates transitions to Aetna programs and plans, makes referrals to clinical resources when appropriate, consults with supervisors and others to overcome barriers, and presents cases at multidisciplinary conferences. Case management must comply with regulatory and company policies and procedures.

This is a 100% work-from-home position. Normal hours are Monday through Friday, 9:00 a.m. to 5:30 p.m. in the employee’s time zone of residence. Occasional evening, weekend, and holiday shifts may be needed. No travel is expected. The position requires an active RN license in the state where the employee resides. The company provides computer equipment and related items; employees provide their own workspace furniture and must meet the stated wired-internet, secure-workspace, location, and technical requirements.

Requirements

• Active RN licensure in the state where the candidate resides.
• At least 2 years of clinical experience as an RN.
• Willingness and ability, if selected, to obtain multiple-state RN licensure after hire; the company pays the expenses.
• Ability to meet work-from-home requirements, including a direct wired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• A quiet, secure, private, organized home workspace compliant with company and HIPAA guidelines and suitable for uninterrupted work.
• Work from within the state and city where the employee has confirmed they currently live.
• Provide personal workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
• Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
• Ability to communicate using digital channels such as email, calendar invitations, Teams messaging, and virtual meetings.
• Experience using Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems, follow basic security practices, troubleshoot common technical issues, and contact IT for unresolved issues.
• Openness to learning new skills as the workplace environment evolves.

Nice To Haves

• Certified Case Manager (CCM) certification.
• Residence in a compact state.
• At least 3 years of experience with Microsoft Office Suite.
• Case management experience in an integrated model.
• Discharge planning experience.
• Managed care experience.
• Bachelor of Science in Nursing (BSN).
• Multiple-state RN licensure.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members by telephone and/or face to face.
• Evaluate members’ medical needs and support their overall wellness.
• Develop proactive courses of action to improve short- and long-term outcomes and identify opportunities to enhance wellness through integration.
• Use clinical tools and information or data review to evaluate member needs and benefit-plan eligibility and facilitate integrative functions and transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators affecting care planning and resolution of member issues.
• Assess all relevant conditions, including comorbidities and multiple diagnoses that affect functionality.
• Review prior claims for their potential impact on current case management and eligibility.
• Assess members’ work capacity and related restrictions or limitations.
• Use a holistic approach to determine whether referrals to clinical resources are needed to assess functionality.
• Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at multidisciplinary case conferences.
• Use case management processes in compliance with regulatory requirements and company policies and procedures.
• Use interviewing skills to engage members and determine health status and needs through questions and conversation.

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