Case Manager, Registered Nurse (Remote)

CVS Health•Work At Home-Massachusetts, MA

7d•$66,575 - $142,576•Remote

About The Position

CVS Health is hiring a Registered Nurse Case Manager to provide member-centered, community-based care management. The role coordinates and facilitates comprehensive care by assessing member needs, developing personalized care plans, coordinating services across providers, advocating for members, and monitoring progress to promote positive outcomes and overall well-being. Case managers collaborate with members, providers, community organizations, and internal multidisciplinary teams to address health care and social determinant needs across the continuum of care. The position is remote and may involve telephonic or in-person contact with members, including visits to homes, worksites, or physician offices. The RN assesses medical and, where appropriate, vocational status; evaluates needs and benefit eligibility; coordinates services and resources; and supports condition management, wellness, timely return to baseline or work, and optimal functioning. Work-from-home colleagues must meet the stated internet, workspace, privacy, security, and location requirements. CVS Health provides computer equipment; the employee supplies workspace furniture.

Requirements

Active and unrestricted RN licensure in Massachusetts; the license section specifies active and unrestricted Compact RN licensure in the state of residence (MA).
Associate’s Degree in Nursing.
At least 2 years of case management, discharge planning, and/or home health care coordination experience.
Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint, as well as proprietary applications.
Ability to work in a fast-paced, high-volume environment using time-management and prioritization skills.
Effective computer skills, including navigating multiple systems and keyboarding.
Working knowledge of problem-solving and decision-making skills.
Working knowledge of medical terminology.
Working knowledge of digital literacy skills.
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 and choose an appropriate option.
Ability to meet work-from-home requirements: direct wired internet connection to a modem/router within 7 feet, minimum speeds of 25 Mbps download and 3 Mbps upload, and no Wi-Fi or satellite internet.
Ability to maintain a quiet, secure, private, organized home workspace that complies with CVS Health and HIPAA guidelines and permits uninterrupted work.
Must work within the state and city where the employee has confirmed they currently live.
Ability to use multiple monitors and applications, communicate through email, calendar invites, Teams messaging and virtual meetings, access secure systems, follow security practices, troubleshoot common technical issues, and learn new skills as the workplace evolves.
Candidate preferably resides in Massachusetts.

Nice To Haves

3 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.

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 phone or in person, including potential visits to homes, worksites, or physician offices.
Assess and analyze members’ medical and/or vocational status and develop plans of care to support condition management, wellness, medical outcomes, timely return to work, or optimal functioning.
Communicate with members and other stakeholders, including medical providers, attorneys, employers, and insurance carriers, by phone or in person as appropriate.
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 as appropriate.
Provide education and prevention information to support the best medical outcomes.
Apply laws and regulations relevant to rehabilitation services and follow instructions from insurance carriers and referral sources.
Evaluate member needs and benefit plan eligibility and facilitate integration using clinical tools and information or data.
Use case management processes in compliance with regulatory and company policies and procedures.
Develop proactive courses of action to address issues, improve short- and long-term outcomes, and support members’ overall wellness.
Monitor member progress toward desired outcomes through assessment and evaluation.