Case Manager, Registered Nurse (Remote)
AI Summary
The Nurse Case Manager delivers comprehensive case management services through telephonic and face-to-face interactions to support member medical needs. They are responsible for assessing, planning, and coordinating care strategies while collaborating with multidisciplinary teams to optimize health outcomes.
Candidates must hold an active, unrestricted RN license and possess at least 3 years of acute care or case management experience. Additionally, 2 years of Med/Surg experience and the ability to work a standard Monday-Friday schedule are required.
Job Details
Benefits
Key Skills
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.
What you will do
- Utilize clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.
- Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
- Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
- Collaborate with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning.
Required Qualifications
- An active and unrestricted RN license in the state of residence.
- Willing and able to obtain additional state licenses upon hire. (Paid for by the company)
- 3+ years' experience of acute care and/or case management.
- 2+ years' Med/Surg experience.
- Must be willing to work Monday-Friday 8:00am-4:30pm local time zone.
Preferred Qualifications
- Prefer candidate in PST Zone.
- Behavioral Health experience.
- Certified Case Manager.
- Managed care experience.
- Strong telephonic communication skills.
- Ability to manage multiple priorities, effective organizational, and time management skills.
- Ability use a computer station and sit for extended periods of time.
Education and Licensing
- Associate's Degree in Nursing.
- RN License in your state of residence.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
About CVS Health
CVS Health is a leading health solutions company enhancing community well-being through accessible care, digital innovation, and a dedicated workforce of over 300,000 professionals.