Registered Nurse - Case Manager - Central Pennsylvania

CVS Health•Allentown, PA

3d•Onsite

About The Position

The RN, Case Manager partners with the primary care provider (PCP) and leads care management activities for complex patients. The role drives care coordination and collaborates with interdisciplinary teams to support continuity of care, prevent avoidable admissions, use resources efficiently, and provide effective team-based care. It is a field-based, in-person/on-site role that builds strong relationships among patients, providers, and care team members. The nurse manages an assigned caseload in a value-based care environment and is accountable for panel performance on admission prevention, readmission prevention, and transitions-of-care metrics. The position coordinates patients’ care, manages transitions after discharge, conducts nursing assessments, provides education, and documents care in the electronic health record. The role is based at Oak Street Health clinics in Bethlehem, Allentown, or Harrisburg, Pennsylvania, subject to adjustment based on clinic needs. Eligible candidates may receive a sign-on bonus.

Requirements

Current RN license in the assigned state.
Minimum of 6–8 years of nursing experience.
Certified Case Manager (CCM), or willingness to obtain certification within 12 months of hire, unless the candidate has 2–3 years of relevant care or case management experience.
Demonstrated skill in motivational interviewing, patient activation, time management, and navigating community and social resources.
Flexible and positive attitude; comfort with ambiguity and change.
High emotional intelligence, including the ability to consider multiple perspectives in resolving problems.
Reliable transportation and ability to travel throughout the communities Oak Street Health serves.
U.S. work authorization.
Ability to embody Oak Street Health’s values, including positive energy, assuming good intentions, creating an unmatched patient experience, driving clinical excellence, taking ownership, delivering results, and determination.

Nice To Haves

Bachelor’s degree in nursing preferred.
2+ years of experience in transitional nursing, emergency room nursing, care coordination, discharge planning, or home health strongly preferred.

Responsibilities

Manage an assigned caseload of complex patients in a value-based care environment, focusing on reducing admissions, readmissions, and medical utilization.
Be accountable for panel metrics related to admission prevention, readmission prevention, and transitions of care.
Own care coordination for assigned patients as the primary point of contact, ensuring alignment, accountability, and follow-through across the care team.
Manage transitions-of-care episodes, including timely structured clinical assessments to identify post-discharge needs, medication reconciliation on behalf of the PCP, and addressing identified needs directly or with other team members.
Collaborate with the patient’s PCP, family or caregiver, social worker, behavioral health specialists, and other care team members to evaluate needs, goals, and actions and ensure care plan progression.
Complete timely documentation of key clinical assessments after admissions while balancing in-center care team planning meetings.
Lead in-person interdisciplinary care planning meetings to coordinate and manage care between provider visits.
Perform timely nursing assessments and provide patient education for chronic condition management and transitions of care.
Educate patients and families, empower them in their care, and advocate for their needs.
Document visits in the electronic health record according to internal standards.
Perform other duties as assigned.

Benefits

Eligible candidates may receive a sign-on bonus as part of the offer package.
Paid vacation and sick time.
401(k) match options and retirement savings options.
Health insurance, including medical, dental, and vision coverage.
Leadership development opportunities.
Continuing education stipends.
Flexible work environments.
Opportunities for high levels of responsibility and rapid advancement.
Paid time off.
Wellness programs and other resources to support physical, emotional, and financial well-being, based on eligibility.
Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.