Case Manager RN

CVS Health • Work At Home-Ohio, OH

20h • $54,095 - $129,615 • Remote

About The Position

The Case Manager RN 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. The goal is to promote optimal, cost-effective outcomes through communication and available resources. The role includes assessing health status and care coordination needs, conducting 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 members meet discharge criteria.

The position requires independent and sound judgment, strong decision-making and interpersonal skills, and the ability to manage multiple priorities using effective organization and time management. It is 100% remote, with no travel expected. 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. The position is full-time, with 40 anticipated weekly hours.

The employee must work from the state and city where they currently live and maintain a quiet, secure, private, and HIPAA-compliant home workspace. A hardwired internet connection is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. CVS Health provides work equipment such as a computer, monitor, keyboard, and headset, while the employee provides workspace furniture. The role involves using multiple monitors and applications, digital communication tools, Microsoft Office 365 or similar software, and secure systems such as VPNs and EHR portals.

Requirements

• Active, current, unrestricted RN license in the state of residence.
• Willingness and ability to obtain additional state licenses upon hire; the company pays for them.
• At least 3 years of acute care experience as an RN.
• 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.
• Ability to obtain a direct, hardwired internet connection to a modem or 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 maintain a quiet, secure, private, tidy, organized, distraction-free, HIPAA-compliant home workspace and work uninterrupted during work hours.
• Work from the state and city where the employee currently lives.
• Ability to use multiple monitors and navigate multiple applications simultaneously.
• Ability to communicate using email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems, follow security practices, and recognize suspicious emails or links.
• Ability to troubleshoot common technical problems independently and contact IT for unresolved issues.
• Openness to learning new skills as the workplace 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 and develop individualized case management programs or referrals to alternative healthcare programs.
• Conduct comprehensive clinical assessments.
• Evaluate member needs and develop flexible approaches based on member needs, benefit plans, and external programs or 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 encourage member engagement and lifestyle or behavior changes.
• Provide coaching, information, education, and support to empower members to make ongoing independent medical and healthy-lifestyle choices.
• Assess member health status and care coordination needs, conduct 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, based on eligibility.
• 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