Case Manager Registered Nurse

CVS Health•Washington, NV

1d•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Nurse Case Manager The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. The Nurse Case Manager utilizes clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes. Key responsibilities include conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health. The Nurse Case Manager reviews prior claims, evaluates work capacity, and determines the need for referrals to clinical resources. Collaboration with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.

Requirements

An active and unrestricted RN license in the state of residence
Willing and able to obtain additional state licenses upon hire (Paid for by the company)
3+ years' experience of acute care and/or case management
2+ years' Med/Surg experience
Must be willing to work Mon-Fri 8-430 PST time zone
Associate's Degree in Nursing
Registered Nurse in your state of residence

Nice To Haves

Prefer candidate in PST Zone
Behavioral Health experience
Certified Case Manager
Managed care experience
Strong telephonic communication skills
Ability to manage multiple priorities, effective organizational, and time management skills
Ability use a computer station and sit for extended periods of time

Responsibilities

Delivering comprehensive case management services through telephonic and/or face-to-face interactions.
Assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness.
Utilizing clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.
Conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
Reviewing prior claims, evaluating work capacity, and determining the need for referrals to clinical resources.
Collaborating with supervisors and multidisciplinary teams to overcome barriers and optimize care planning.
Operating within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines.
Utilizing strong interviewing and engagement skills to understand member needs and facilitate smooth transitions to appropriate programs and services.