Case Manager Registered Nurse

CVS Health•Work At Home-Pennsylvania, PA

23h•$60,522 - $129,615•Remote

About The Position

The RN Case Manager is responsible for assessing members by phone and/or face to face, planning and implementing care, and coordinating case management activities to evaluate medical needs and support overall wellness. This role is 100% remote, with applicants eligible from any state, provided they work the stated hours and meet work-from-home requirements. Less than 5% travel may be required for on-site meetings, training, system updates, or licensure requirements. The role requires a private, secure home workspace, high-speed wired internet, and the ability to work at a computer for extended periods. The company provides equipment such as a computer, monitor, keyboard, and headset; employees provide their own workspace furniture. The scheduled shift is eight hours, Monday through Friday between 8:30 a.m. and 5:00 p.m. in the employee’s time zone. Weekends and holidays may be required based on departmental needs; currently, coverage is on-call and volunteer-based. The position is full-time, with 40 anticipated weekly hours. The role is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the stated base pay range.

Requirements

Active, current, unrestricted RN license in the state of residence; nurses in Nurse Licensure Compact jurisdictions must be able to use their compact license without restriction.
Willingness and ability to obtain additional state licenses after hire; the company pays for these licenses.
At least 3 years of acute-care RN clinical experience, such as general medical, post-surgical, specialty care including pediatrics or ICU, case management, or discharge planning.
Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods.
A private, designated workspace free of distractions and high-speed internet.
Ability to obtain a direct, hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Ability to work within the state and city where the employee has confirmed they currently live.
Ability to meet work-from-home requirements, including maintaining a quiet, secure, private, organized workspace compliant with CVS Health and HIPAA guidelines and uninterrupted work during work hours.
Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to access secure systems such as a VPN or EHR portal, secure a computer when unattended, manage strong passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently and contact IT when issues cannot be resolved.
Associate degree in Nursing.

Nice To Haves

Compact RN licensure.
At least 1 year of case management experience.
Certified Case Manager (CCM) certification.
Strong customer service skills, including attentiveness, sensitivity to certain issues, and proactive identification and resolution of issues.
Experience with Microsoft Office applications, including PowerPoint, Excel, and Word.
Strong telephonic communication skills.
At least 1 year of experience using computers and navigating multiple monitors while speaking by telephone.
Bachelor of Science in Nursing.
Openness to learning new skills as the workplace environment evolves.

Responsibilities

Assess members telephonically and/or face to face, and plan, implement, and coordinate case management activities to evaluate medical needs and facilitate overall wellness.
Collaboratively develop proactive courses of action to address member issues, improve short- and long-term outcomes, and identify opportunities to enhance overall wellness through integration.
Use clinical tools and information or data reviews, including assessments and claims, to evaluate members’ needs and available benefits, and collaborate and refer members to programs offered by the plan sponsor.
Apply clinical judgment to reduce risk factors and address complex health issues and social indicators.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Use interviewing skills to maximize member engagement and discern health status and needs through questions and conversation.