Case Manager RN - Field (Richmond/Central Virginia)

CVS Health•Field-Virginia, VA

8d•$60,522 - $129,615•Hybrid

About The Position

Join a team dedicated to improving health outcomes for Medicare and Medicaid members with complex medical, behavioral, and social needs. As an RN Case Manager, you will play a critical role in delivering holistic, member-centered care by collaborating with members, caregivers, providers, community partners, and interdisciplinary teams. This position offers an opportunity to make a meaningful impact by addressing clinical needs, social determinants of health, and care coordination challenges while supporting members in achieving their health and wellness goals. This is a field-based position located in Richmond VA/Central Region. Candidates must reside within a commutable distance of the assigned service area. The RN Case Manager serves as a frontline advocate for members, providing comprehensive care management services through telephonic, virtual, home-based, community-based, and facility-based interactions. Responsibilities include assessing member needs, developing individualized care plans, coordinating services, addressing barriers to care, and promoting improved health outcomes through effective care management interventions. The role requires conducting visits in members' homes, hospitals, skilled nursing facilities, and other care settings as needed to support transitions of care, discharge planning, and ongoing care coordination.

Requirements

Active and unrestricted Registered Nurse (RN) license in Virginia (Compact License accepted where applicable).
Minimum of 2 years of clinical nursing experience.
Willing and able to travel up to 50-75% within the assigned service area to conduct member visits in homes, hospitals, skilled nursing facilities, and other care settings as needed.
Valid driver's license, reliable transportation, and proof of automobile insurance.
Ability to work independently in a remote and field-based environment.

Nice To Haves

2 years of Case Management, Care Coordination, Disease Management, Discharge Planning, Home Health, Population Health, or related experience.
Experience working with Medicare, Medicaid, Dual Eligible, or complex populations.
Knowledge of care management principles, utilization management, and community-based resources.
Certified Case Manager (CCM) certification preferred or willingness to obtain.

Responsibilities

Conduct face-to-face visits with members in a variety of settings, including homes, hospitals, skilled nursing facilities, rehabilitation centers, and other community-based locations, as appropriate.
Conduct comprehensive assessments of members' medical, behavioral health, functional, psychosocial, and social determinant needs.
Collaborate with hospital care teams to support discharge planning, transition-of-care activities, and post-discharge follow-up.
Develop, implement, monitor, and update individualized care plans that support member goals and improve health outcomes.
Utilize clinical judgment, evidence-based practices, and available data to identify risks, gaps in care, and opportunities for intervention.
Coordinate services across the continuum of care, including providers, specialists, community resources, and interdisciplinary teams.
Coordinate with facility staff and treating providers to address barriers to discharge, medication adherence, follow-up appointments, and community support needs.
Facilitate transitions of care and support members in navigating complex healthcare systems.
Identify and address barriers that may impact treatment adherence, access to care, and overall wellness.
Identify members during inpatient admissions and engage with members, caregivers, and providers to facilitate safe, timely, and appropriate transitions across the continuum of care.
Apply motivational interviewing and member engagement techniques to encourage participation in care plans and self-management activities.
Collaborate with healthcare providers, caregivers, and community organizations to support comprehensive care delivery.
Participate in interdisciplinary case conferences and consult with leadership as needed regarding complex cases.
Maintain accurate and timely documentation in accordance with regulatory, accreditation, and organizational requirements.
Ensure compliance with all applicable federal, state, and company policies, procedures, and standards.