Case Manager RN

CVS Health • Carolina, NC

1d • Remote

About The Position

The Case Manager RN works remotely and may live in any state. The role uses a collaborative process of assessment, planning, facilitation, and advocacy to connect members with options and services that meet their benefit-plan and health needs, promoting optimal and cost-effective outcomes. This includes assessing health status and care-coordination needs, inpatient review and discharge planning, developing and implementing case-management plans, monitoring and evaluating those plans, involving the Medical Director when indicated, and closing cases when discharge criteria are met.

The position calls for independent, sound judgment; strong decision-making and interpersonal skills; and the ability to manage multiple priorities with effective organization, time management, and teamwork. Normal hours are Monday through Friday, 8:00 a.m. to 4:30 p.m. in the employee’s time zone of residence, with an occasional late-shift rotation of 11:00 a.m. to 8:00 p.m. Eastern Time once per quarter. No travel is expected.

The employee must meet the company’s work-from-home requirements, including a direct wired internet connection meeting specified speed requirements and a quiet, secure, private, HIPAA-compliant workspace. The company provides computer equipment and related peripherals; the employee supplies workspace furniture. The role also requires comfort navigating multiple applications and monitors, using digital communication and collaboration tools, accessing secure systems, following security practices, and troubleshooting common technical issues.

Requirements

• Current, active, unrestricted RN license in the state of residence.
• Willingness and ability to obtain additional state licenses after hire; the company pays for them.
• At least 3 years of acute-care experience as an RN.
• Ability and willingness to work Monday through Friday, 8:00 a.m. to 4:30 p.m. in the time zone of residence, with an occasional 11:00 a.m. to 8:00 p.m. Eastern Time shift once per quarter.
• Associate degree required.
• Meet work-from-home requirements, including a direct wired connection to a modem or router within 7 feet of the computer, minimum internet speeds of 25 Mbps download and 3 Mbps upload, and no Wi-Fi or satellite internet.
• Maintain a quiet, secure, private, tidy, organized, distraction-free home workspace compliant with company and HIPAA guidelines.
• Work from within the state and city where the employee has confirmed they live.
• Provide workspace furniture, such as a desk or standing desk.
• Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Communicate using digital channels such as email, calendar invitations, Teams messaging, and virtual meetings.
• Use Microsoft Office 365 applications or similar tools such as Google Workspace.
• Access secure systems such as VPNs and EHR portals, follow computer and password security practices, and recognize suspicious emails or links.
• Resolve common technical issues independently and contact IT for unresolved issues.
• Be open to learning new skills as the workplace environment evolves.

Nice To Haves

• Compact RN license or multistate licensure.
• Certified Case Manager (CCM).
• Managed care experience.
• Hospital experience in ICU, CCU, Step Down, ER, or OR.
• Telephonic case-management and/or telephonic experience.
• Bachelor’s degree.

Responsibilities

• Use data-driven methods to identify members for individualized case-management programs or referrals to alternative health-care programs.
• Conduct comprehensive clinical assessments.
• Evaluate needs and develop flexible approaches based on member needs, benefit plans, or external programs and services.
• Advocate for patients to the full extent of their existing health-care coverage.
• Promote quality, cost-effective outcomes and suggest improvements to program or operational efficiency.
• Identify and escalate quality-of-care issues through established channels.
• Provide a very high level of customer service.
• Assess members’ health literacy, technology capabilities, and readiness to change.
• Use influencing and motivational-interviewing skills to support member engagement and lifestyle or behavior changes.
• Provide coaching, information, education, and support so members can make ongoing independent medical and healthy-lifestyle choices.
• Assess members’ health status and care-coordination needs, perform inpatient review and discharge planning, and develop, implement, monitor, and evaluate case-management plans.
• Involve the Medical Director when indicated and close cases when members meet discharge criteria.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.
• 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