Case Manager RN

CVS Health•Work At Home-Pennsylvania, PA

1d•$60,522 - $129,615•Remote

About The Position

CVS Health is hiring a fully remote Registered Nurse Case Manager to help members navigate complex healthcare needs through personalized care planning, advocacy, and coordination. The role is nationwide, requires no travel, and follows a Monday–Friday schedule. The standard schedule is 8:00 AM–4:30 PM in the employee’s local time zone, with occasional rotating late shifts and holiday on-call coverage as needed. The Case Manager conducts telephonic assessments of members’ medical, behavioral, and social needs; develops individualized care plans; identifies barriers to care; and coordinates with providers, programs, and community resources. The position reviews clinical information, claims history, and benefit eligibility, and uses motivational interviewing and clinical judgment to support member engagement and goal achievement. The role also collaborates with multidisciplinary teams and ensures compliance with regulatory requirements and company case management standards. Work-from-home requirements include a direct wired internet connection meeting specified speed requirements, a quiet and secure private workspace compliant with company and HIPAA guidelines, and working from the state and city where the employee has confirmed residence. The company provides computer equipment and related peripherals; employees provide their own workspace furniture. The role involves extended periods at a desk and requires comfort using multiple monitors, applications, digital communication and collaboration tools, and secure systems such as VPNs and EHR portals. Employees should be able to troubleshoot common technical issues and learn new skills as the workplace evolves.

Requirements

Active, unrestricted RN license in the state of residence.
Ability to obtain multi-state or compact licensure; the company pays for this.
At least 3 years of clinical nursing experience.
At least 1 year of experience using Microsoft Office, including Outlook, Word, and Excel.
Ability to work Monday–Friday with schedules starting as early as 8:00 AM in the local time zone.
Ability to participate in rotating late shifts, up to 8:00 PM EST, and holiday on-call coverage as needed.
Associate Degree in Nursing required.
Ability to obtain or have a direct, hardwired internet connection to a modem/router within 7 feet of the computer, with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private designated home workspace that is free from distractions, organized, compliant with CVS Health and HIPAA guidelines, and allows uninterrupted work.
Work from the state and city where residence has been confirmed.
Provide personal workspace furniture, such as a desk or standing desk, and comply with work-from-home requirements.
Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
Ability to communicate using 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, protect devices and passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently and contact IT for unresolved issues.
Openness to learning new skills as the workplace evolves.

Nice To Haves

Compact RN license.
Case Management experience.
Case Manager Certification (CCM or equivalent).
Bachelor of Science in Nursing (BSN).

Responsibilities

Conduct telephonic assessments to evaluate members’ medical, behavioral, and social needs.
Develop individualized care plans to support improved health outcomes and overall wellness.
Identify barriers to care and implement strategies to reduce risk and improve member engagement.
Coordinate care across providers, programs, and community resources.
Review clinical information, claims history, and benefit eligibility to support appropriate interventions.
Use motivational interviewing and clinical judgment to engage members and support goal achievement.
Collaborate with multidisciplinary teams to address complex cases and facilitate optimal outcomes.
Ensure compliance with regulatory requirements and company case management standards.
Participate in rotating late shifts and holiday on-call coverage as needed.
Use multiple monitors and applications, digital communication and collaboration tools, and secure systems; troubleshoot common technical issues.